Covered Entity Details

DSH140114 SWEDISH COVENANT HEALTH (Active) - information as of 6/6/2025 4:24:42 AM

Main Details

Name

SWEDISH COVENANT HEALTH

Subdivision Name

Type

Disproportionate Share Hospital

Rural

340B ID

DSH140114

Medicare Provider Number

140114

Additional Details

Current Program Status

Active

Registration Date

4/21/2008

Participating Start Date

7/1/2004

Participating Approval Date

4/21/2008

Last Recertification Date

8/12/2024

Contacts

Authorizing Official

Swedish Covenant Health
Jonathan Lind, Chief Operating Officer
(773) 907-1028 Ext: 1028

Primary Contact

Swedish Covenant Health
Alicia Juska, Director Pharmacy
(773) 878-8200 Ext: 5379

Addresses

Street Address

5145 N CALIFORNIA
CHICAGO, IL 60625

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
2/23/12 remove Medicaid info 8/31/04 MODIF ADDR (WAS 2745 W FOSTER AVENUE, ZIP 60613)	02/23/2012
8/31/04 MODIF ADDR (WAS 2745 W FOSTER AVENUE, ZIP 60613)	04/21/2008

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	362179813001, 362179813401,362179813011,362179813521,364073303002,364073303003	1831151257,1588739734,1497825855

Shipping Addresses

Shipping Address 1

SWEDISH COVENANT HOSPITAL
5145 N CALIFORNIA AVE
CHICAGO, IL 60625-3661

Shipping Address 2

SWEDISH COVENANT HEALTH DBA GALTER MEDICAL PAVILION PHARMACY
5140 N CALIFORNIA AVE
# G105
CHICAGO, IL 60625-3645

Shipping Address 3

SWEDISH COVENANT HEALTH DBA FOSTER MEDICAL PAVILION PHARMACY
5215 N CALIFORNIA AVE
STE F103
CHICAGO, IL 60625-8565

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Termination Date	Last Updated On
Contract Detail	AVELLA OF DEER VALLEY, INC. #38	DBA AVELLA SPECIALTY PHARMACY	24416 N. 19TH AVE	PHOENIX	AZ	85085	04/20/2017	07/01/2017	09/30/2020	09/30/2020
Contract Detail	BOND DRUG COMPANY OF ILLINOIS LLC	DBA: WALGREENS #12150	5158 N. LINCOLN AVE	CHICAGO	IL	60625	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 01593	5230 N MILWAUKEE AVE	CHICAGO	IL	60630	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04542	5625 N. RIDGE AVE	CHICAGO	IL	60660-3434	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04862	4343 N CENTRAL AVE	CHICAGO	IL	60634	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04936	4040 N. CICERO AVE.	CHICAGO	IL	60641	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05057	3153 W IRVING PARK RD	CHICAGO	IL	60618	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS #13454	6140 N WESTERN AVE	CHICAGO	IL	60659	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	04/06/2022	07/01/2022		07/01/2022
Contract Detail	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/14/2020	07/14/2020		07/22/2020
Contract Detail	PREMIER SPECIALTY INFUSION LLC	2401 HASSEL RD. SUITE # 1525		HOFFMAN ESTATES	IL	60169-6016	10/16/2017	01/01/2018	03/03/2020	03/03/2020
Contract Detail	SWEDISH COVENANT HEALTH	DBA GALTER MEDICAL PAVILION PHARMACY	5140 N CALIFORNIA AVE # G105	CHICAGO	IL	60625	07/11/2013	10/01/2013	01/08/2024	01/09/2024
Contract Detail	SWEDISH COVENANT HEALTH	DBA FOSTER MEDICAL PAVILION PHARMACY	5215 N CALIFORNIA AVE STE F103	CHICAGO	IL	60625	07/11/2013	10/01/2013	11/16/2023	11/17/2023
Contract Detail	WALGREEN CO	DBA: WALGREENS #15525	201 E. HURON STREET, SUITE 01-210	CHICAGO	IL	60611	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	07/06/2023	10/01/2023	05/01/2025	05/01/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 00194	4801 N LINCOLN AVE	CHICAGO	IL	60625	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 00252	7510 N WESTERN AVE	CHICAGO	IL	60645	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 03950	4343 N KEDZIE AVE	CHICAGO	IL	60618	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06980	3019 W PETERSON AVE	CHICAGO	IL	60659-3417	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09358	6798 N LINCOLN AVE	LINCOLNWOOD	IL	60712	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09709	4010 W LAWRENCE AVE	CHICAGO	IL	60630	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	WALGREEN CO.	DBA: WALGREENS #13798	5440 N. CLARK ST.	CHICAGO	IL	60640	07/17/2018	10/01/2018	05/01/2025	05/01/2025
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	07/02/2021	10/01/2021	06/30/2022	06/30/2022
Contract Detail	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	07/02/2021	10/01/2021	06/30/2022	06/30/2022

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH140114B	Child	DSH	SWEDISH COVENANT HEALTH	WOUND CARE CLINIC	2751 W. WINNONA AVENUE, AP3 FLOOR	CHICAGO	IL	Active
DSH140114C	Child	DSH	SWEDISH COVENANT HEALTH	PAIN MANAGEMENT CLINIC	5215 N. California Ave.	CHICAGO	IL	ToBeTerminated
DSH140114D	Child	DSH	SWEDISH COVENANT HEALTH	OPERATING ROOM / ONE DAY SURGICAL PATIENTS	5140 N. CALIFORNIA AVENUE, SUITE #G200	CHICAGO	IL	Active
DSH140114E	Child	DSH	SWEDISH COVENANT HEALTH	EMERGENCY / DISCHARGE PATIENTS	5145 N. CALIFORNIA AVENUE	CHICAGO	IL	Active
DSH140114G	Child	DSH	SWEDISH COVENANT HEALTH	INFUSION / CANCER CENTER	5140 N. CALIFORNIA AVENUE	CHICAGO	IL	Active
DSH140114J	Child	DSH	Swedish Covenant Hospital	Outpatient Oncology Infusion Center Evanston	800 Austin Ave.	Evanston	IL	Terminated
DSH140114K	Child	DSH	SWEDISH COVENANT HEALTH	Ambulatory Surgery	5215 N. California Ave.	Chicago	IL	Active
DSH140114L	Child	DSH	SWEDISH COVENANT HEALTH	SWEDISH HOSPITAL INFUSION CENTER NI - Infusion Center	6450 W TOUHY AVE	NILES	IL	Active
DSH140114M	Child	DSH	SWEDISH COVENANT HEALTH	Swedish Hospital - Oncology	757 PARK AVE W	HIGHLAND PARK	IL	Active
DSH140114N	Child	DSH	SWEDISH COVENANT HEALTH	Swedish Hospital - Oncology	2650 RIDGE AVE	EVANSTON	IL	Active
DSH140114P	Child	DSH	SWEDISH COVENANT HEALTH	Swedish Hospital - Oncology	2180 PFINGSTEN RD	GLENVIEW	IL	Active
DSH140114Q	Child	DSH	SWEDISH COVENANT HEALTH	Swedish Hospital - Oncology Infusion Center	120 Spalding Drive	Naperville	IL	Approved
DSH140114R	Child	DSH	SWEDISH COVENANT HEALTH	Swedish Hospital - Oncology Infusion Center	24600 W. 127th Street	Plainfield	IL	Approved
DSH140114S	Child	DSH	SWEDISH COVENANT HEALTH	Swedish Hospital - Oncology and Specialty Infusion Center	3060 W Salt Creek Lane	Arlington Heights	IL	Approved
DSH140114T	Child	DSH	SWEDISH COVENANT HEALTH	Swedish Hospital - Oncology Infusion Center	177 E. Brush Hill Road	Elmhurst	IL	Approved

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Authorizing Official	Update	Change Request	Lind, Jonathan Chief Operating Officer Swedish Covenant Health 7739071028	Lind, Jonathan Chief Operating Officer Swedish Covenant Health 7739071028-1028	5/13/2025 9:37 AM
Details	Last Recertification Date	Update	Recertification	9/3/2023 10:52:03 PM	8/12/2024 6:21:03 PM	8/12/2024 6:21 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/7/2024 4:13 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		364073303002	6/7/2024 4:13 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IL	6/7/2024 4:13 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	6/7/2024 4:13 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		364073303003	6/7/2024 4:13 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IL	6/7/2024 4:13 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1588739734	6/7/2024 4:13 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	6/7/2024 4:13 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1497825855	6/7/2024 4:13 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	6/7/2024 4:13 PM
Addresses	Shipping Address	Update	Change Request	SWEDISH COVENANT HEALTH DBA GALTER MEDICAL PAVILION PHARMACY 5140 N CALIFORNIA AVE CHICAGO, IL 60625-3600	SWEDISH COVENANT HEALTH DBA GALTER MEDICAL PAVILION PHARMACY 5140 N CALIFORNIA AVE # G105 CHICAGO, IL 60625-3645	12/15/2023 2:06 PM
Addresses	Shipping Address	Insert	Change Request		SWEDISH COVENANT HOSPITAL 5145 N CALIFORNIA AVE CHICAGO, IL 60625-3661	11/8/2023 7:29 AM
Addresses	Shipping Address	Insert	Change Request		SWEDISH COVENANT HEALTH DBA GALTER MEDICAL PAVILION PHARMACY 5140 N CALIFORNIA AVE CHICAGO, IL 60625-3600	11/8/2023 7:29 AM
Addresses	Shipping Address	Insert	Change Request		SWEDISH COVENANT HEALTH DBA FOSTER MEDICAL PAVILION PHARMACY 5215 N CALIFORNIA AVE STE F103 CHICAGO, IL 60625-8565	11/8/2023 7:29 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1005928 (AK)		11/8/2023 7:29 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	95011656 (CO)		11/8/2023 7:29 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	300002997 (IN)		11/8/2023 7:29 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	7279061 (MS)		11/8/2023 7:29 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	140114 (TN)		11/8/2023 7:29 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1831151257 (VA)		11/8/2023 7:29 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	1831151257 (WI)		11/8/2023 7:29 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	24266 (AZ)		11/8/2023 7:29 AM
Medicaid Billing	NPI: Number	Delete	Change Request	1831151257 (MS)		11/8/2023 7:29 AM
Details	Last Recertification Date	Update	Recertification	9/9/2022 10:17:03 AM	9/3/2023 10:52:03 PM	9/3/2023 10:52 PM
Details	Last Recertification Date	Update	Recertification	8/18/2021 10:42:40 AM	9/9/2022 10:17:03 AM	9/9/2022 10:17 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1831151257	4/6/2022 9:45 AM
Medicaid Billing	NPI: State	Insert	Change Request		MS	4/6/2022 9:45 AM
Details	Last Recertification Date	Update	Recertification	9/11/2020 12:46:18 PM	8/18/2021 10:42:40 AM	8/18/2021 10:42 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	244266 (AZ)		3/1/2021 2:35 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	3/1/2021 2:35 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		24266	3/1/2021 2:35 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		AZ	3/1/2021 2:35 PM
Contacts	Authorizing Official	Update	Change Request	King, Patricia Vice President Legal Affairs Swedish Covenant Hospital 7739898811	Lind, Jonathan Chief Operating Officer Swedish Covenant Health 7739071028	10/6/2020 2:27 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		362179813011	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		362179813521	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IL	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1005928	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AK	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		244266	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		AZ	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		95011656	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		CO	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		300002997	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		IN	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		7279061	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		MS	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		140114	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		TN	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1831151257	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		VA	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Recertification		False	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: Number	Insert	Recertification		1831151257	9/11/2020 12:46 PM
Medicaid Billing	Medicaid: State	Insert	Recertification		WI	9/11/2020 12:46 PM
Medicaid Billing	NPI: Number	Insert	Recertification		1831151257	9/11/2020 12:46 PM
Medicaid Billing	NPI: State	Insert	Recertification		IL	9/11/2020 12:46 PM
Medicaid Billing	NPI: Number	Delete	Recertification	1831151257 ( )		9/11/2020 12:46 PM
Details	Last Recertification Date	Update	Recertification	8/28/2019 8:54:21 AM	9/11/2020 12:46:18 PM	9/11/2020 12:46 PM
Details	Last Recertification Date	Update	Recertification	8/24/2018 7:35:43 AM	8/28/2019 8:54:21 AM	8/28/2019 8:54 AM
Details	Entity Name	Update	Change Request	SWEDISH COVENANT HOSPITAL	SWEDISH COVENANT HEALTH	4/11/2019 2:06 PM
Contacts	Primary Contact	Update	Change Request	Juska, Alicia Director Pharmacy Swedish Covenant Health 7738788200-4726	Juska, Alicia Director Pharmacy Swedish Covenant Health 7738788200-5379	4/5/2019 5:14 PM
Contacts	Primary Contact	Update	Change Request	Patel, Ramesh Director Pharmacy Swedish Covenant Hospital 7738788200-5379	Juska, Alicia Director Pharmacy Swedish Covenant Health 7738788200-4726	3/28/2019 7:02 AM
Details	Last Recertification Date	Update	Recertification	11/29/2017 2:57:56 PM	8/24/2018 7:35:43 AM	8/24/2018 7:35 AM
Details	Last Recertification Date	Update	Recertification	8/19/2016 12:00:00 AM	11/29/2017 2:57:56 PM	11/29/2017 2:57 PM
Contacts	Primary Contact	Update	Recertification	Patel, Ramesh Director Pharmacy 7738788200-5379	Patel, Ramesh Director Pharmacy Swedish Covenant Hospital 7738788200-5379	11/29/2017 12:28 PM
Contacts	Authorizing Official	Update		King, Patricia Vice President Legal Affairs 7739898811	King, Patricia Vice President Legal Affairs Swedish Covenant Hospital 7739898811	10/11/2017 12:04 PM
Contacts	Authorizing Official	Insert			King, Patricia Vice President Legal Affairs 7739898811	4/20/2017 3:34 PM
Contacts	Primary Contact	Insert			Patel, Ramesh Director Pharmacy 7738788200-5379	2/14/2017 8:39 PM
Addresses	Main Address	Insert			5145 N CALIFORNIA CHICAGO, IL 60625	8/19/2016 11:32 AM
Details	Last Recertification Date	Update		8/25/2015 12:00:00 AM	8/19/2016 12:00:00 AM	8/19/2016 11:32 AM
Details	Last Recertification Date	Update		8/28/2014 12:00:00 AM	8/25/2015 12:00:00 AM	8/25/2015 8:40 AM
Medicaid Billing	Medicaid: Number	Update		364073303002	362179813001, 362179813401	7/29/2015 5:28 PM
Medicaid Billing	NPI: Number	Update		1588739734	1831151257	7/29/2015 5:28 PM
Details	Last Recertification Date	Update		8/22/2013 12:00:00 AM	8/28/2014 12:00:00 AM	8/28/2014 3:46 PM
Details	Entity Subname	Update		SCH PHARMACY		8/28/2013 2:39 PM
Details	Last Recertification Date	Update		7/1/2012 12:00:00 AM	8/22/2013 12:00:00 AM	8/22/2013 5:37 AM
Medicaid Billing	Medicaid: Is Primary	Insert			False	2/14/2013 10:13 AM
Medicaid Billing	Medicaid: Number	Insert			364073303002	2/14/2013 10:13 AM
Medicaid Billing	Medicaid: State	Insert			IL	2/14/2013 10:13 AM
Medicaid Billing	NPI: Number	Insert			1588739734	2/14/2013 10:13 AM
Details	Last Recertification Date	Update			7/1/2012 12:00:00 AM	5/14/2012 9:07 AM
Dates	Participating Approval Date	Update		4/21/2008 2:51:28 PM	4/21/2008 12:00:00 AM	2/23/2012 6:30 PM
Details	Comments Public	Insert			2/23/12 remove Medicaid info 8/31/04 MODIF ADDR (WAS 2745 W FOSTER AVENUE, ZIP 60613)	2/23/2012 6:30 PM
Details	Last Recertification Date	Insert				4/21/2008 2:54 PM
Details	Grant Number	Insert				4/21/2008 2:54 PM
Details	340B ID	Insert			DSH140114	4/21/2008 2:54 PM
Details	Is Authorizing Official EHB Data	Insert				4/21/2008 2:54 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/21/2008 2:54 PM
Details	Medicare Provider Number	Insert			140114	4/21/2008 2:54 PM
Details	Entity Name	Insert			SWEDISH COVENANT HOSPITAL	4/21/2008 2:54 PM
Details	Program Code	Insert			DSH	4/21/2008 2:54 PM
Details	Entity Subname	Insert			SCH PHARMACY	4/21/2008 2:54 PM
Dates	Participating Approval Date	Insert			4/21/2008 2:51:28 PM	4/21/2008 2:54 PM
Details	State	Insert			Active	4/21/2008 2:54 PM
Dates	Registration Date	Insert			4/21/2008 12:00:00 AM	4/21/2008 2:54 PM
Dates	Signed By Date	Insert				4/21/2008 2:54 PM
Dates	Start Date	Insert			7/1/2004 12:00:00 AM	4/21/2008 2:54 PM
Terminations	Termination Comments	Insert				4/21/2008 2:54 PM
Terminations	Termination Date	Insert				4/21/2008 2:54 PM
Terminations	Termination Effective Date	Insert				4/21/2008 2:54 PM
Terminations	Termination Reason	Insert				4/21/2008 2:54 PM
Details	Comments Public	Insert			8/31/04 MODIF ADDR (WAS 2745 W FOSTER AVENUE, ZIP 60613)	4/21/2008 2:54 PM