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ASCENSION RX 1001
DSH140080 PRESENCE SAINT FRANCIS HOSPITAL
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Covered Entity Details
Entity Name
PRESENCE SAINT FRANCIS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140080
Entity Address
355 RIDGE AVE.
EVANSTON, IL 60202
Medicare Provider Number
140080
Participating Start Date
7/1/2007
Last Recertification Date
8/16/2024
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
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Flavio Marin, CFO
(847) 316-4190
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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