Covered Entity Details

DSH140088P THE UNIVERSITY OF CHICAGO MEDICAL CENTER (Active) - information as of 6/6/2025 12:38:26 PM

Main Details

Name

THE UNIVERSITY OF CHICAGO MEDICAL CENTER

Subdivision Name

Orland Park - PET CT

Type

Disproportionate Share Hospital

Rural

Yes

340B ID

DSH140088P

Medicare Provider Number

140088

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/8/2024

Participating Start Date

1/1/2025

Participating Approval Date

10/21/2024

Last Recertification Date

Contacts

Authorizing Official

The University of Chicago Medical Center
Denise Scarpelli, Vice President, Chief Pharmacy Officer
(773) 834-5601

Primary Contact

The University of Chicago Medical Center
Brent E Fiedler, Director, Pharmacy Contracting, Finance, and Metrics
(773) 702-2289

Addresses

Street Address

14290 S LaGrange Road
Orland Park, IL 60462

Billing Address

THE UNIVERSITY OF CHICAGO MEDICAL CENTER
150 HARVESTER DRIVE
BURR RIDGE, IL 60527

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IL		1508956509

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH140088F	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	The University of Chicago Medicine Comprehensive Cancer Center at Silver Cross	1850 Silver Cross Blvd.	New Lenox	IL	Active
DSH140088G	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	The University of Chicago Outpatient Senior Health Center at South Shore	7101 S. Exchange Ave.	Chicago	IL	Active
DSH140088H	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	University of Chicago Medicine Center for Advanced Care at Orland Park - Radiation Oncology	14290 S LaGrange Road	Orland Park	IL	Terminated
DSH140088J	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	University of Chicago Medicine Center for Advanced Care at Orland Park - MRI	14290 S LaGrange Road	Orland Park	IL	Terminated
DSH140088K	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	University of Chicago Medicine Center for Advanced Care at Orland Park - CT	14290 S LaGrange Road	Orland Park	IL	Terminated
DSH140088L	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	University of Chicago Medicine Center for Advanced Care at Orland Park - Infusion Therapy	14290 S LaGrange Road	Orland Park	IL	Active
DSH140088M	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	University of Chicago Medicine - Infusion Therapy	14290 S LaGrange Road	Orland Park	IL	Terminated
DSH140088N	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	River East Infusion - River East Infusion	355 E Grand	Chicago	IL	Active
DSH140088P	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	Orland Park - PET CT	14290 S LaGrange Road	Orland Park	IL	Active
DSH140088Q	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	Northbrook - Infusion	400 Skokie Blvd.	Northbrook	IL	Active
DSH140088R	Child	DSH	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	University of Chicago Medicine - Crown Point Infusion	10855 VIRGINIA ST	CROWN POINT	IN	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		Approved	Active	1/1/2025 12:01 AM
Addresses	Main Address	Update	Change Request	THE UNIVERSITY OF CHICAGO MEDICAL CENTER for Advanced Care at Orland Park - PET CT Orland Park, IL 60462	14290 S LaGrange Road Orland Park, IL 60462	10/24/2024 7:04 AM
Details	Entity Subname	Update	Change Request	Orland Park - Pet CT	Orland Park - PET CT	10/24/2024 7:04 AM
Contacts	Signed By	Insert	New Registration		Scarpelli, Denise Vice President, Chief Pharmacy Officer The University of Chicago Medical Center 7738345601	10/21/2024 7:17 AM
Details	340B ID	Update	New Registration		DSH140088P	10/21/2024 7:17 AM
Details	Entity Name	Update	New Registration	UNIVERSITY OF CHICAGO HOSPITALS	THE UNIVERSITY OF CHICAGO MEDICAL CENTER	10/21/2024 7:17 AM
Details	Entity Subname	Update	New Registration	Orland Park	Orland Park - Pet CT	10/21/2024 7:17 AM
Dates	Participating Approval Date	Update	New Registration		10/21/2024 7:17:35 AM	10/21/2024 7:17 AM
Details	State	Update	New Registration	Pending	Approved	10/21/2024 7:17 AM
Dates	Signed By Date	Update	New Registration		10/16/2024 5:38:56 PM	10/21/2024 7:17 AM
Dates	Start Date	Update	New Registration		1/1/2025 12:00:00 AM	10/21/2024 7:17 AM
Addresses	Main Address	Insert	New Registration		THE UNIVERSITY OF CHICAGO MEDICAL CENTER for Advanced Care at Orland Park - PET CT Orland Park, IL 60462	10/8/2024 12:13 PM
Addresses	Billing Address	Insert	New Registration		THE UNIVERSITY OF CHICAGO MEDICAL CENTER 150 HARVESTER DRIVE BURR RIDGE, IL 60527	10/8/2024 12:13 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1508956509	10/8/2024 12:13 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	10/8/2024 12:13 PM
Contacts	Authorizing Official	Insert	New Registration		Scarpelli, Denise Vice President, Chief Pharmacy Officer The University of Chicago Medical Center 7738345601	10/8/2024 12:13 PM
Contacts	Primary Contact	Insert	New Registration		Fiedler, Brent E Director, Pharmacy Contracting, Finance, and Metrics The University of Chicago Medical Center 7737022289	10/8/2024 12:13 PM
Details	Assistance Received From Date	Insert	New Registration			10/8/2024 12:13 PM
Details	Assistance Received To Date	Insert	New Registration			10/8/2024 12:13 PM
Details	Last Recertification Date	Insert	New Registration			10/8/2024 12:13 PM
Details	Grant Number	Insert	New Registration			10/8/2024 12:13 PM
Details	340B ID	Insert	New Registration			10/8/2024 12:13 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/8/2024 12:13 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/8/2024 12:13 PM
Details	Medicare Provider Number	Insert	New Registration		140088	10/8/2024 12:13 PM
Details	Entity Name	Insert	New Registration		UNIVERSITY OF CHICAGO HOSPITALS	10/8/2024 12:13 PM
Details	NOFO Number	Insert	New Registration			10/8/2024 12:13 PM
Details	Program Code	Insert	New Registration		DSH	10/8/2024 12:13 PM
Details	Entity Subname	Insert	New Registration		Orland Park	10/8/2024 12:13 PM
Dates	Participating Approval Date	Insert	New Registration			10/8/2024 12:13 PM
Details	State	Insert	New Registration		Pending	10/8/2024 12:13 PM
Dates	Registration Date	Insert	New Registration		10/8/2024 12:13:01 PM	10/8/2024 12:13 PM
Dates	Signed By Date	Insert	New Registration			10/8/2024 12:13 PM
Dates	Start Date	Insert	New Registration			10/8/2024 12:13 PM
Terminations	Termination Comments	Insert	New Registration			10/8/2024 12:13 PM
Terminations	Termination Date	Insert	New Registration			10/8/2024 12:13 PM
Terminations	Termination Effective Date	Insert	New Registration			10/8/2024 12:13 PM
Terminations	Termination Reason	Insert	New Registration			10/8/2024 12:13 PM