Covered Entity Details

DSH140124L JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY (Active) - information as of 4/29/2025 4:36:04 AM

Main Details

Name

JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY

Subdivision Name

Cook County Health at Belmont Cragin (formerly LOGAN SQUARE CLINIC)

Type

Disproportionate Share Hospital

Rural

340B ID

DSH140124L

Medicare Provider Number

140124

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

4/3/2013

Participating Start Date

10/1/2013

Participating Approval Date

8/30/2013

Last Recertification Date

8/15/2024

Contacts

Authorizing Official

Cook County Health
Pamela Cassara, Chief Financial Officer
(312) 864-5507

Primary Contact

Cook County Health & Hospitals System
CaTanya Norwood, Senior Director of Pharmacy
(312) 864-2213

Addresses

Street Address

5501 W. Fullerton Avenue
Chicago, IL 60639

Billing Address
Same as Street Address

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	366006541054,366006541073	1689794489,1588612832,1750912648
IN	300064318,300062812	1689794489,1588612832

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
Contract Detail	PROVIDENT HOSPITAL OF COOK COUNTY	ATTENTION PHARMACY DEPARTMENT	500 E 51ST ST ROOM 2050	CHICAGO	IL	60615-2400	06/20/2019	07/01/2019	07/01/2019		07/09/2019

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
DSH140124A	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Cook County Health at Blue Island Health Center (Formerly OAK FOREST HEALTH CENTER)	12757 S Western Ave.	Blue Island	IL	Active
DSH140124AA	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	COOK COUNTY - John H. Stroger, Jr. Telemedicine	1901W HARRISON ST	CHICAGO	IL	Active
DSH140124AB	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Cook County Health at Blue Island Health Center - Specialty Care - Blue Island Specialty Care	12757 S. Western Ave.	Blue Island	IL	Active
DSH140124AC	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Gynecology Tumor Clinic - Gynecology Tumor Clinic	1950 West Polk Street	Chicago	IL	Active
DSH140124AD	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Urology - Urology	1950 West Polk Street	Chicago	IL	Active
DSH140124AE	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Breast/Surgical Oncology - Surgery Oncology	1950 West Polk Street	Chicago	IL	Active
DSH140124AF	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Cancer Genetics - Cancer Genetics	1950 West Polk Street	Chicago	IL	Active
DSH140124AG	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Dermatology Pediatrics - Dermatology Pediatrics	1950 West Polk Street	Chicago	IL	Active
DSH140124AH	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Psychiatry Oncology - Psychiatry Oncology	1950 West Polk Street	Chicago	IL	Active
DSH140124AJ	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Diabetes - Diabetes	1950 West Polk Street	Chicago	IL	Active
DSH140124AK	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Hematology Clinic - Clinical Hematology	1950 West Polk Street	Chicago	IL	Active
DSH140124B	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	CORE CLINIC	2020 W Harrison St.	Chicago	IL	Active
DSH140124C	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	CHILD ADVOCACY CENTER	1240 South Damen Ave	Chicago	IL	Terminated
DSH140124D	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	MORTON EAST CLINIC	2423 South Austin Blvd	Cicero	IL	Active
DSH140124E	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	WOODY WINSTON CLINIC	650 E. Phoenix Center Drive	Phoenix	IL	Terminated
DSH140124F	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	WOODLAWN CLINIC	6337 S. Woodlawn Avenue	Chicago	IL	Terminated
DSH140124G	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Cook County Health at Arlington Heights (formerly VISTA CLINIC)	3250 N. Arlington Heights Rd.	Arlington Heights	IL	Active
DSH140124H	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	ROBBINS CLINIC	13450 S. Kedzie Avenue	Robbins	IL	Active
DSH140124J	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	PRIETO CLINIC	2424 S. Pulaski Road	Chicago	IL	Active
DSH140124K	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	NEAR SOUTH HEALTH CENTER	3525 S. Michigan Avenue	Chicago	IL	Terminated
DSH140124L	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Cook County Health at Belmont Cragin (formerly LOGAN SQUARE CLINIC)	5501 W. Fullerton Avenue	Chicago	IL	Active
DSH140124M	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	FANTUS HEALTH CENTER	1901 West Harrison Street	Chicago	IL	Terminated
DSH140124N	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	COTTAGE GROVE CLINIC	1645 Cottage Grove	Ford Heights	IL	Active
DSH140124P	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	ENGLEWOOD CLINIC	1135 W. 69th Street	Chicago	IL	Active
DSH140124Q	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Cook County Health at North Riverside (formerly known as CICERO CLINIC)	1800 S. Harlem Avenue	North Riverside	IL	Active
DSH140124R	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	AUSTIN CLINIC	4800 W. Chicago Avenue	Chicago	IL	Active
DSH140124S	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Breast/Cervical Screening	1950 West Polk Street	CHICAGO	IL	Active
DSH140124T	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Endocrinology	1950 West Polk Street	Chicago	IL	Active
DSH140124U	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Hematology/Oncology	1950 West Polk Street	Chicago	IL	Active
DSH140124V	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Infusion Center	1950 West Polk Street	CHICAGO	IL	Active
DSH140124W	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Dermatology/Oncology	1950 West Polk Street	CHICAGO	IL	Active
DSH140124X	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - Ophthalmology	1950 West Polk Street	CHICAGO	IL	Active
DSH140124Y	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	Professional Building - General Medicine Clinic (GMC)	1950 West Polk Street	CHICAGO	IL	Active
DSH140124Z	Child	DSH	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	COOK COUNTY HEALTH PROFESSIONAL BLD - Professional Building - Oral Health (Dental)	1950 W POLK ST	CHICAGO	IL	Active

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	9/5/2023 10:20:52 AM	8/15/2024 1:31:44 PM	8/15/2024 1:31 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1750912648	8/9/2024 12:05 PM
Medicaid Billing	NPI: State	Insert	Change Request		IL	8/9/2024 12:05 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/18/2023 5:01 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		300062812	9/18/2023 5:01 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	9/18/2023 5:01 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	9/18/2023 5:01 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		366006541073	9/18/2023 5:01 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	9/18/2023 5:01 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1588612832	9/18/2023 5:01 PM
Medicaid Billing	NPI: State	Insert	Change Request		IN	9/18/2023 5:01 PM
Medicaid Billing	NPI: Number	Insert	Change Request		1588612832	9/18/2023 5:01 PM
Medicaid Billing	NPI: State	Insert	Change Request		IL	9/18/2023 5:01 PM
Details	Last Recertification Date	Update	Recertification	8/24/2022 8:48:25 AM	9/5/2023 10:20:52 AM	9/5/2023 10:20 AM
Details	Last Recertification Date	Update	Recertification	9/8/2021 11:23:07 AM	8/24/2022 8:48:25 AM	8/24/2022 8:48 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	8/24/2022 8:44 AM
Medicaid Billing	Medicaid: Number	Insert	Change Request		300064318	8/24/2022 8:44 AM
Medicaid Billing	Medicaid: State	Insert	Change Request		IN	8/24/2022 8:44 AM
Medicaid Billing	NPI: Number	Insert	Change Request		1689794489	8/24/2022 8:44 AM
Medicaid Billing	NPI: State	Insert	Change Request		IN	8/24/2022 8:44 AM
Contacts	Authorizing Official	Update	Change Request	Gibson, Andrea Maureen Interim Chief Business Officer Cook County Health 3128640953	Cassara, Pamela Chief Financial Officer Cook County Health 3128645507	11/2/2021 10:56 AM
Addresses	Main Address	Update	Change Request	2840 W. Fullerton Avenue Chicago, IL 60647	5501 W. Fullerton Avenue Chicago, IL 60639	10/27/2021 2:23 PM
Details	Entity Subname	Update	Change Request	LOGAN SQUARE CLINIC	Cook County Health at Belmont Cragin (formerly LOGAN SQUARE CLINIC)	10/27/2021 2:23 PM
Details	Last Recertification Date	Update	Recertification	9/2/2020 5:26:27 PM	9/8/2021 11:23:07 AM	9/8/2021 11:23 AM
Medicaid Billing	NPI: State	Update	Recertification		IL	9/2/2020 5:26 PM
Details	Last Recertification Date	Update	Recertification	9/13/2019 5:38:02 PM	9/2/2020 5:26:27 PM	9/2/2020 5:26 PM
Contacts	Authorizing Official	Update	Change Request	Akpan, Ekerete Chief Financial Officer Cook County Health & Hospitals System 3128646827	Gibson, Andrea Maureen Interim Chief Business Officer Cook County Health 3128640953	5/4/2020 1:27 PM
Details	Last Recertification Date	Update	Recertification	9/12/2018 7:05:07 PM	9/13/2019 5:38:02 PM	9/13/2019 5:38 PM
Contacts	Authorizing Official	Update	Change Request	Elwell, Douglas Deputy Chief Executive Officer Cook County health and Hospitals System 3128646827	Akpan, Ekerete Chief Financial Officer Cook County Health & Hospitals System 3128646827	2/8/2019 1:57 PM
Details	Last Recertification Date	Update	Recertification	11/30/2017 10:09:57 AM	9/12/2018 7:05:07 PM	9/12/2018 7:05 PM
Details	Last Recertification Date	Update	Recertification	9/6/2016 12:00:00 AM	11/30/2017 10:09:57 AM	11/30/2017 10:09 AM
Contacts	Authorizing Official	Update		Elwell, Douglas Deputy Chief Executive Officer 3128646827	Elwell, Douglas Deputy Chief Executive Officer Cook County health and Hospitals System 3128646827	10/11/2017 8:09 AM
Contacts	Primary Contact	Update		Norwood, CaTanya Senior Director of Pharmacy 3128642213	Norwood, CaTanya Senior Director of Pharmacy Cook County Health & Hospitals System 3128642213	10/10/2017 6:21 PM
Contacts	Primary Contact	Update		Shannon, John Jay Chief of Clinical Integration 3128645504	Norwood, CaTanya Senior Director of Pharmacy 3128642213	5/23/2017 9:57 AM
Contacts	Authorizing Official	Update		Daniels, Peter W. COO, Inpatient Services 3128645507	Elwell, Douglas Deputy Chief Executive Officer 3128646827	5/23/2017 9:57 AM
Contacts	Signed By	Insert			MORALES, JOHN CFO 3128644680	2/22/2017 12:26 PM
Addresses	Main Address	Insert			2840 W. Fullerton Avenue Chicago, IL 60647	9/6/2016 12:56 PM
Details	Last Recertification Date	Update		9/1/2015 12:00:00 AM	9/6/2016 12:00:00 AM	9/6/2016 12:56 PM
Details	Last Recertification Date	Update		9/8/2014 12:00:00 AM	9/1/2015 12:00:00 AM	9/1/2015 7:13 AM
Contacts	Authorizing Official	Insert			Daniels, Peter W. COO, Inpatient Services 3128645507	10/30/2014 5:06 PM
Contacts	Primary Contact	Update		Yates, Rhonda System Director of Pharmacy 3128642193	Shannon, John Jay Chief of Clinical Integration 3128645504	9/8/2014 3:31 PM
Details	Last Recertification Date	Update			9/8/2014 12:00:00 AM	9/8/2014 3:31 PM
Contacts	Primary Contact	Insert			Yates, Rhonda System Director of Pharmacy 3128642193	11/4/2013 9:49 AM
Dates	Participating Approval Date	Update			8/30/2013 12:00:00 AM	8/30/2013 2:10 PM
Details	State	Update		Pending	Active	8/30/2013 2:10 PM
Dates	Start Date	Update			10/1/2013 12:00:00 AM	8/30/2013 2:10 PM
Details	340B ID	Update		Z_Hold 4OUTPATIENT_ONLINE_REG	DSH140124L	8/20/2013 3:55 PM
Details	340B ID	Update		OUTPATIENT_ONLINE_REG	Z_Hold 4OUTPATIENT_ONLINE_REG	5/21/2013 1:02 PM
Medicaid Billing	Medicaid: Is Primary	Insert			False	4/3/2013 12:44 PM
Medicaid Billing	Medicaid: Number	Insert			366006541054	4/3/2013 12:44 PM
Medicaid Billing	Medicaid: State	Insert			IL	4/3/2013 12:44 PM
Medicaid Billing	NPI: Number	Insert			1689794489	4/3/2013 12:44 PM
Details	Last Recertification Date	Insert				4/3/2013 12:44 PM
Details	Grant Number	Insert				4/3/2013 12:44 PM
Details	340B ID	Insert			OUTPATIENT_ONLINE_REG	4/3/2013 12:44 PM
Details	Is Authorizing Official EHB Data	Insert				4/3/2013 12:44 PM
Dates	Last Date That 340B Drugs Purchased	Insert				4/3/2013 12:44 PM
Details	Medicare Provider Number	Insert			140124	4/3/2013 12:44 PM
Details	Entity Name	Insert			JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	4/3/2013 12:44 PM
Details	Program Code	Insert			DSH	4/3/2013 12:44 PM
Details	Entity Subname	Insert			LOGAN SQUARE CLINIC	4/3/2013 12:44 PM
Dates	Participating Approval Date	Insert				4/3/2013 12:44 PM
Details	State	Insert			Pending	4/3/2013 12:44 PM
Dates	Registration Date	Insert			4/3/2013 12:00:00 AM	4/3/2013 12:44 PM
Dates	Signed By Date	Insert			4/3/2013 12:00:00 AM	4/3/2013 12:44 PM
Dates	Start Date	Insert				4/3/2013 12:44 PM
Terminations	Termination Comments	Insert				4/3/2013 12:44 PM
Terminations	Termination Date	Insert				4/3/2013 12:44 PM
Terminations	Termination Effective Date	Insert				4/3/2013 12:44 PM
Terminations	Termination Reason	Insert				4/3/2013 12:44 PM