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FRANCISCAN ALLIANCE INC
DSH140172 FRANCISCAN HEALTH OLYMPIA FIELDS
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH OLYMPIA FIELDS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140172
Entity Address
20201 SOUTH CRAWFORD AVE
OLYMPIA FIELDS, IL 60461
Medicare Provider Number
140172
Participating Start Date
4/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
FRANCISCAN ALLIANCE INC
Pharmacy Address
DBA FRANCISCAN OUTPATIENT PHARMACY OLYMP
20201 CRAWFORD AVE
OLYMPIA FIELDS, IL 60461-1010
Pharmacy Comments
Contract Details
Approval Date
1/7/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tony Banda, CFO
(708) 756-1000 Ext: 56090
Contract Pharmacy Representative
Franciscan Health
Laura Shondell, Administrative Director Medication Systems and Operations
(765) 423-6900
Signed By Date
1/7/2016
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