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ASCENSION RX 1001
DSH140174 PRESENCE MERCY MEDICAL CENTER
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Covered Entity Details
Entity Name
PRESENCE MERCY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140174
Entity Address
1325 NORTH HIGHLAND AVENUE, ATTN: ADMINISTRATION
AURORA, IL 60506
Medicare Provider Number
140174
Participating Start Date
4/1/2010
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
ASCENSION RX 1001
Pharmacy Address
ASCENSION PHARMACY SERVICES, LLC.
7701 METROPOLIS DR STE 200B
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
10/8/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kevin Larkin, Chief Financial Officer
(630) 801-2729
Contract Pharmacy Representative
Ascension Pharmacy Services, LLC
Lynn Eschenbacher, Chief Pharmacy Officer
(314) 884-0593
Signed By Date
10/8/2021
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