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PRESENCE HEALTHCARE SERVICES
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
PRESENCE HEALTHCARE SERVICES
Pharmacy Address
SFH PROF BLDG PHARMACY
800 AUSTIN STREET #101 WEST
EVANSTON, IL 60202
Pharmacy Comments
Contract Details
Approval Date
9/8/2010
Contract Begin Date
9/15/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Rick Fischer, System Director 340B
(630) 914-2872
Signed By Date
5/31/2007
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