340B Drug Pricing Program Database


DSH140124A JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY (Active) - information as of 5/5/2025 11:59:01 PM

Main Details
JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY
Cook County Health at Blue Island Health Center (Formerly OAK FOREST HEALTH CENTER)
Disproportionate Share Hospital
No
DSH140124A
140124


Additional Details
Active
7/1/2013
10/1/2013
8/30/2013
8/15/2024

Contacts

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

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

Addresses

12757 S Western Ave.
Blue Island, IL 60406

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Parent/Child
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

Yes
StateMedicaid NumberNPI Number
IL366006541083,366006541073,366006541070,366006541081,3660065410491649551938,1043238298,1942508460,1649390022,1588612832,1457982340
IN300064536,300072816,3000628121649390022,1043238298,1588612832
Shipping Addresses

Cook County Health at Blue Island Health Center (formerly Oak Forest Pharmacy)
12757 Western Ave
Blue Island, IL 60406
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailPROVIDENT HOSPITAL OF COOK COUNTYATTENTION PHARMACY DEPARTMENT 500 E 51ST ST
ROOM 2050
CHICAGOIL60615-240006/20/201907/01/201907/01/2019 01/17/2020
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH140124AChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCook County Health at Blue Island Health Center (Formerly OAK FOREST HEALTH CENTER)12757 S Western Ave.Blue IslandILActive
DSH140124AAChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCOOK COUNTY - John H. Stroger, Jr. Telemedicine1901W HARRISON STCHICAGOILActive
DSH140124ABChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCook County Health at Blue Island Health Center - Specialty Care - Blue Island Specialty Care12757 S. Western Ave.Blue IslandILActive
DSH140124ACChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Gynecology Tumor Clinic - Gynecology Tumor Clinic1950 West Polk StreetChicagoILActive
DSH140124ADChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Urology - Urology1950 West Polk StreetChicagoILActive
DSH140124AEChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Breast/Surgical Oncology - Surgery Oncology1950 West Polk StreetChicagoILActive
DSH140124AFChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Cancer Genetics - Cancer Genetics1950 West Polk StreetChicagoILActive
DSH140124AGChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Dermatology Pediatrics - Dermatology Pediatrics1950 West Polk StreetChicagoILActive
DSH140124AHChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Psychiatry Oncology - Psychiatry Oncology1950 West Polk StreetChicagoILActive
DSH140124AJChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Diabetes - Diabetes1950 West Polk StreetChicagoILActive
DSH140124AKChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Hematology Clinic - Clinical Hematology1950 West Polk StreetChicagoILActive
DSH140124BChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCORE CLINIC2020 W Harrison St.ChicagoILActive
DSH140124CChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCHILD ADVOCACY CENTER1240 South Damen AveChicagoILTerminated
DSH140124DChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYMORTON EAST CLINIC2423 South Austin BlvdCiceroILActive
DSH140124EChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYWOODY WINSTON CLINIC650 E. Phoenix Center DrivePhoenixILTerminated
DSH140124FChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYWOODLAWN CLINIC6337 S. Woodlawn AvenueChicagoILTerminated
DSH140124GChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCook County Health at Arlington Heights (formerly VISTA CLINIC)3250 N. Arlington Heights Rd.Arlington HeightsILActive
DSH140124HChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYROBBINS CLINIC13450 S. Kedzie AvenueRobbinsILActive
DSH140124JChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYPRIETO CLINIC2424 S. Pulaski RoadChicagoILActive
DSH140124KChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYNEAR SOUTH HEALTH CENTER3525 S. Michigan AvenueChicagoILTerminated
DSH140124LChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCook County Health at Belmont Cragin (formerly LOGAN SQUARE CLINIC)5501 W. Fullerton AvenueChicagoILActive
DSH140124MChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYFANTUS HEALTH CENTER1901 West Harrison StreetChicagoILTerminated
DSH140124NChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCOTTAGE GROVE CLINIC1645 Cottage GroveFord HeightsILActive
DSH140124PChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYENGLEWOOD CLINIC1135 W. 69th StreetChicagoILActive
DSH140124QChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCook County Health at North Riverside (formerly known as CICERO CLINIC)1800 S. Harlem AvenueNorth RiversideILActive
DSH140124RChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYAUSTIN CLINIC4800 W. Chicago AvenueChicagoILActive
DSH140124SChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Breast/Cervical Screening1950 West Polk StreetCHICAGOILActive
DSH140124TChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Endocrinology1950 West Polk StreetChicagoILActive
DSH140124UChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Hematology/Oncology1950 West Polk StreetChicagoILActive
DSH140124VChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Infusion Center1950 West Polk StreetCHICAGOILActive
DSH140124WChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Dermatology/Oncology1950 West Polk StreetCHICAGOILActive
DSH140124XChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - Ophthalmology1950 West Polk StreetCHICAGOILActive
DSH140124YChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYProfessional Building - General Medicine Clinic (GMC)1950 West Polk StreetCHICAGOILActive
DSH140124ZChildDSHJOHN H. STROGER, JR. HOSPITAL OF COOK COUNTYCOOK COUNTY HEALTH PROFESSIONAL BLD - Professional Building - Oral Health (Dental)1950 W POLK STCHICAGOILActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsLast Recertification DateUpdateRecertification9/5/2023 10:19:28 AM8/15/2024 1:25:37 PM8/15/2024 1:25 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 14579823408/9/2024 12:04 PM
Medicaid BillingNPI: StateInsertGroup Change Request IL8/9/2024 12:04 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/18/2023 5:03 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3000628129/18/2023 5:03 PM
Medicaid BillingMedicaid: StateInsertChange Request IN9/18/2023 5:03 PM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False9/18/2023 5:03 PM
Medicaid BillingMedicaid: NumberInsertChange Request 3660065410739/18/2023 5:03 PM
Medicaid BillingMedicaid: StateInsertChange Request IL9/18/2023 5:03 PM
Medicaid BillingNPI: NumberInsertChange Request 15886128329/18/2023 5:03 PM
Medicaid BillingNPI: StateInsertChange Request IN9/18/2023 5:03 PM
Medicaid BillingNPI: NumberInsertChange Request 15886128329/18/2023 5:03 PM
Medicaid BillingNPI: StateInsertChange Request IL9/18/2023 5:03 PM
DetailsLast Recertification DateUpdateRecertification8/24/2022 8:54:20 AM9/5/2023 10:19:28 AM9/5/2023 10:19 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False3/31/2023 4:07 PM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 3000728163/31/2023 4:07 PM
Medicaid BillingMedicaid: StateInsertGroup Change Request IN3/31/2023 4:07 PM
Medicaid BillingNPI: NumberInsertGroup Change Request 10432382983/31/2023 4:07 PM
Medicaid BillingNPI: StateInsertGroup Change Request IN3/31/2023 4:07 PM
DetailsLast Recertification DateUpdateRecertification9/8/2021 11:25:43 AM8/24/2022 8:54:20 AM8/24/2022 8:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertGroup Change Request False8/24/2022 8:45 AM
Medicaid BillingMedicaid: NumberInsertGroup Change Request 3000645368/24/2022 8:45 AM
Medicaid BillingMedicaid: StateInsertGroup Change Request IN8/24/2022 8:45 AM
Medicaid BillingNPI: NumberInsertGroup Change Request 16493900228/24/2022 8:45 AM
Medicaid BillingNPI: StateInsertGroup Change Request IN8/24/2022 8:45 AM
AddressesShipping AddressDeleteChange RequestOak Forest Health Center 15900 S. Cicero Avenue F21/F22 Oak Forest, IL 60452 6/2/2022 2:55 PM
AddressesShipping AddressDeleteChange RequestOak Central Pharmacy 15900 S. CICERO AVENUE BLDG F 2nd Floor Oak Forest, IL 60452 6/2/2022 2:55 PM
ContactsAuthorizing OfficialUpdateChange RequestGibson, Andrea Maureen Interim Chief Business Officer Cook County Health 3128640953Cassara, Pamela Chief Financial Officer Cook County Health 312864550711/2/2021 10:56 AM
DetailsLast Recertification DateUpdateRecertification9/2/2020 5:23:50 PM9/8/2021 11:25:43 AM9/8/2021 11:25 AM
AddressesShipping AddressDeleteChange RequestOak Forest Pharmacy 15900 S. CICERO AVENUE Oak Forest, IL 60452-0000 11/18/2020 8:34 AM
AddressesShipping AddressInsertChange Request Cook County Health at Blue Island Health Center (formerly Oak Forest Pharmacy) 12757 Western Ave Blue Island, IL 6040611/18/2020 8:34 AM
Medicaid BillingNPI: StateUpdateRecertification IL9/2/2020 5:23 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/2/2020 5:23 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/2/2020 5:23 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/2/2020 5:23 PM
DetailsLast Recertification DateUpdateRecertification9/13/2019 5:37:35 PM9/2/2020 5:23:50 PM9/2/2020 5:23 PM
AddressesShipping AddressInsertChange Request Oak Forest Health Center 15900 S. Cicero Avenue F21/F22 Oak Forest, IL 604526/4/2020 1:33 PM
AddressesMain AddressUpdateChange Request 15900 S. CICERO AVENUE F21/F22 OAK FOREST, IL 60452 12757 S Western Ave. Blue Island, IL 604066/4/2020 1:33 PM
DetailsEntity SubnameUpdateChange RequestOAK FOREST HEALTH CENTERCook County Health at Blue Island Health Center (Formerly OAK FOREST HEALTH CENTER)6/4/2020 1:33 PM
ContactsAuthorizing OfficialUpdateChange RequestAkpan, Ekerete Chief Financial Officer Cook County Health & Hospitals System 3128646827Gibson, Andrea Maureen Interim Chief Business Officer Cook County Health 31286409535/4/2020 1:27 PM
DetailsLast Recertification DateUpdateRecertification9/12/2018 7:05:24 PM9/13/2019 5:37:35 PM9/13/2019 5:37 PM
ContactsAuthorizing OfficialUpdateChange RequestElwell, Douglas Deputy Chief Executive Officer Cook County health and Hospitals System 3128646827Akpan, Ekerete Chief Financial Officer Cook County Health & Hospitals System 31286468272/8/2019 1:57 PM
DetailsLast Recertification DateUpdateRecertification11/30/2017 10:01:35 AM9/12/2018 7:05:24 PM9/12/2018 7:05 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False11/30/2017 10:01 AM
Medicaid BillingMedicaid: NumberInsertRecertification 36600654107011/30/2017 10:01 AM
Medicaid BillingMedicaid: StateInsertRecertification IL11/30/2017 10:01 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False11/30/2017 10:01 AM
Medicaid BillingMedicaid: NumberInsertRecertification 36600654108111/30/2017 10:01 AM
Medicaid BillingMedicaid: StateInsertRecertification IL11/30/2017 10:01 AM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False11/30/2017 10:01 AM
Medicaid BillingMedicaid: NumberInsertRecertification 36600654104911/30/2017 10:01 AM
Medicaid BillingMedicaid: StateInsertRecertification IL11/30/2017 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 104323829811/30/2017 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 194250846011/30/2017 10:01 AM
Medicaid BillingNPI: NumberInsertRecertification 164939002211/30/2017 10:01 AM
DetailsLast Recertification DateUpdateRecertification9/6/2016 12:00:00 AM11/30/2017 10:01:35 AM11/30/2017 10:01 AM
ContactsAuthorizing OfficialUpdate Elwell, Douglas Deputy Chief Executive Officer 3128646827Elwell, Douglas Deputy Chief Executive Officer Cook County health and Hospitals System 312864682710/11/2017 8:09 AM
ContactsPrimary ContactUpdate Norwood, CaTanya Senior Director of Pharmacy 3128642213Norwood, CaTanya Senior Director of Pharmacy Cook County Health & Hospitals System 312864221310/10/2017 6:21 PM
ContactsPrimary ContactUpdate Shannon, John Jay Chief of Clinical Integration 3128645504Norwood, CaTanya Senior Director of Pharmacy 31286422135/23/2017 9:57 AM
ContactsAuthorizing OfficialUpdate Daniels, Peter W. COO, Inpatient Services 3128645507Elwell, Douglas Deputy Chief Executive Officer 31286468275/23/2017 9:57 AM
ContactsSigned ByInsert  MORALES, JOHN CFO 31286446802/22/2017 12:26 PM
DetailsLast Recertification DateUpdate 9/1/2015 12:00:00 AM9/6/2016 12:00:00 AM9/6/2016 12:56 PM
AddressesMain AddressInsert   15900 S. CICERO AVENUE F21/F22 OAK FOREST, IL 604529/6/2016 12:56 PM
DetailsLast Recertification DateUpdate 9/8/2014 12:00:00 AM9/1/2015 12:00:00 AM9/1/2015 7:13 AM
AddressesShipping AddressInsert  Oak Central Pharmacy 15900 S. CICERO AVENUE BLDG F 2nd Floor Oak Forest, IL 604528/4/2015 10:35 AM
AddressesShipping AddressInsert  Oak Forest Pharmacy 15900 S. CICERO AVENUE Oak Forest, IL 60452-00008/4/2015 10:35 AM
ContactsAuthorizing OfficialUpdate Cookinham, John CFO 3128644686Daniels, Peter W. COO, Inpatient Services 312864550710/30/2014 5:06 PM
ContactsPrimary ContactInsert  Shannon, John Jay Chief of Clinical Integration 31286455049/8/2014 3:31 PM
DetailsLast Recertification DateUpdate  9/8/2014 12:00:00 AM9/8/2014 3:31 PM
ContactsAuthorizing OfficialInsert  Cookinham, John CFO 312864468610/17/2013 3:53 PM
DatesParticipating Approval DateUpdate  8/30/2013 12:00:00 AM8/30/2013 1:52 PM
DetailsStateUpdate PendingActive8/30/2013 1:52 PM
DatesStart DateUpdate  10/1/2013 12:00:00 AM8/30/2013 1:52 PM
Details340B IDUpdate ONHOLD_STROGERDSH140124A8/20/2013 3:37 PM
Details340B IDUpdate OUTPATIENT_ONLINE_REGONHOLD_STROGER7/2/2013 10:30 AM
Medicaid BillingMedicaid: Is PrimaryInsert  False7/1/2013 10:03 AM
Medicaid BillingMedicaid: NumberInsert  3660065410837/1/2013 10:03 AM
Medicaid BillingMedicaid: StateInsert  IL7/1/2013 10:03 AM
Medicaid BillingNPI: NumberInsert  16495519387/1/2013 10:03 AM
DetailsLast Recertification DateInsert   7/1/2013 10:03 AM
DetailsGrant NumberInsert   7/1/2013 10:03 AM
Details340B IDInsert  OUTPATIENT_ONLINE_REG7/1/2013 10:03 AM
DetailsIs Authorizing Official EHB DataInsert   7/1/2013 10:03 AM
DatesLast Date That 340B Drugs PurchasedInsert   7/1/2013 10:03 AM
DetailsMedicare Provider NumberInsert  1401247/1/2013 10:03 AM
DetailsEntity NameInsert  JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY7/1/2013 10:03 AM
DetailsProgram CodeInsert  DSH7/1/2013 10:03 AM
DetailsEntity SubnameInsert  OAK FOREST HEALTH CENTER7/1/2013 10:03 AM
DatesParticipating Approval DateInsert   7/1/2013 10:03 AM
DetailsStateInsert  Pending7/1/2013 10:03 AM
DatesRegistration DateInsert  7/1/2013 12:00:00 AM7/1/2013 10:03 AM
DatesSigned By DateInsert  7/1/2013 12:00:00 AM7/1/2013 10:03 AM
DatesStart DateInsert   7/1/2013 10:03 AM
TerminationsTermination CommentsInsert   7/1/2013 10:03 AM
TerminationsTermination DateInsert   7/1/2013 10:03 AM
TerminationsTermination Effective DateInsert   7/1/2013 10:03 AM
TerminationsTermination ReasonInsert   7/1/2013 10:03 AM