340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OSF HOME INFUSION PHARMACY
DSH140179 OSF Little Company of Mary Medical Center
Print
Covered Entity Details
Entity Name
OSF Little Company of Mary Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140179
Entity Address
2800 WEST 95TH STREET
EVERGREEN PARK, IL 60805
Medicare Provider Number
140179
Participating Start Date
10/1/2021
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OSF HOME INFUSION PHARMACY
Pharmacy Address
2265 W ALTORFER DR
PEORIA, IL 61615-1807
Pharmacy Comments
Contract Details
Approval Date
10/13/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
OSF Healthcare
Kelly J Taylor, Manager Pharmacy
(309) 624-5464
Signed By Date
10/13/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session