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ASCENSION RX 1001
DSH140217 PRESENCE SAINT JOSEPH HOSPITAL ELGIN
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Covered Entity Details
Entity Name
PRESENCE SAINT JOSEPH HOSPITAL ELGIN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140217
Entity Address
77 NORTH AIRLITE ST.
ELGIN, IL 60123
Medicare Provider Number
140217
Participating Start Date
4/1/2021
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
1/10/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kevin Larkin, CFO
(847) 888-3696
Contract Pharmacy Representative
Ascension
Michael Wascovich, Chief Pharmacy Officer
(216) 633-7400
Signed By Date
1/10/2024
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