340B Drug Pricing Program Database


DSH140208B ADVOCATE CHRIST MEDICAL CENTER (Terminated) - information as of 6/9/2025 11:01:42 PM

Main Details
ADVOCATE CHRIST MEDICAL CENTER
Physical Therapy - Tinley Park Rehab
Disproportionate Share Hospital
No
DSH140208B
140208


Additional Details
Terminated
10/3/2019
1/1/2020
10/31/2019
9/2/2022

10/1/2023
Business decision by the Covered Entity

Contacts

Advocate Aurora Health Care
Nan Nelson, SVP-Finance
(414) 378-4765

Advocate Aurora Health
Jason G Nowak, Director, Pharmacy 340B Program
(414) 640-8457

Addresses

18210 S. La Grange Road
Tinley Park, IL 60487

Advocate Christ Medical Center
4440 W 95th Street
Oak Lawn, IL 60453


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

Yes
StateMedicaid NumberNPI Number
IL362169147001,362169147403,362169147065,362169147066,362169147074,3621691474741508315516,1548375082,1386188068,1922542604
WI362169147001,362169147065,362169147066,362169147074,362169147403,3621691474741386188068,1508315516,1548375082,1922542604
Shipping Addresses

Advocate Christ Medical Center
4440 W 95th Street
Oak Lawn, IL 60453

Advocate Central Service Center
15-17 W. College Dr
Arlington Heights, IL 60004
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
DSH140208AChildDSHADVOCATE CHRIST MEDICAL CENTERPhysical Therapy - Peds Rehab Outpatient Pavillion12350 S. HarlemPalos HeightsILTerminated
DSH140208BChildDSHADVOCATE CHRIST MEDICAL CENTERPhysical Therapy - Tinley Park Rehab18210 S. La Grange RoadTinley ParkILTerminated
DSH140208CChildDSHADVOCATE CHRIST MEDICAL CENTERElectrocardiology - Cardiac Rehab Off-site11800 Southwest HwyPalos HeightsILTerminated
DSH140208DChildDSHADVOCATE CHRIST MEDICAL CENTERRadiology - Breast Health4545 W 103rd StOak LawnILActive
DSH140208EChildDSHADVOCATE CHRIST MEDICAL CENTERAmbulatory Care - ACH Behavioral Health Service4700 W 95th stOak LawnILActive
DSH140208FChildDSHADVOCATE CHRIST MEDICAL CENTERDreyer Infusion Clinic - Infusion services1221 N Highland Avenue 1st FloorAuroraILActive
DSH140208GChildDSHADVOCATE CHRIST MEDICAL CENTERAmbulatory Care - Wilmette Clinic3232 Lake AveWilmetteILActive
DSH140208HChildDSHADVOCATE CHRIST MEDICAL CENTERCMC Transplant Clinic - Transplant4400 W 95th StOak LawnILActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
ContactsPrimary ContactUpdateChange RequestNowak, Jason Director, Pharmacy 340B Program Advocate Aurora Health 4146408457Nowak, Jason G Director, Pharmacy 340B Program Advocate Aurora Health 41464084577/22/2024 3:54 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestNelson, Nan SVP-Finance Advocate Aurora Health Care 4142991610Nelson, Nan SVP-Finance Advocate Aurora Health Care 41437847652/7/2024 11:14 AM
DetailsStateUpdate To Be TerminatedTerminated10/1/2023 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 9/30/2023 12:00:00 AM7/13/2023 7:18 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated7/13/2023 7:18 AM
TerminationsTermination DateUpdateTermination Request 10/1/2023 12:00:00 AM7/13/2023 7:18 AM
TerminationsTermination Effective DateUpdateTermination Request 9/30/2023 12:00:00 AM7/13/2023 7:18 AM
TerminationsTermination ReasonUpdateTermination Request Business decision by the Covered Entity7/13/2023 7:18 AM
DetailsLast Recertification DateUpdateRecertification9/10/2021 12:45:43 PM9/2/2022 12:13:58 PM9/2/2022 12:13 PM
ContactsPrimary ContactUpdateGroup Change RequestDe Ianni, Angela Vice President Pharmacy Supply Chain Advocate Aurora Health Care 4146301541Nowak, Jason Director, Pharmacy 340B Program Advocate Aurora Health 41464084575/4/2022 11:16 AM
ContactsPrimary ContactUpdateProfile Change RequestDe Ianni, Angela Director Supply Chain, Pharmacy Advocate Aurora Health Care 4146301541De Ianni, Angela Vice President Pharmacy Supply Chain Advocate Aurora Health Care 414630154110/7/2021 12:57 PM
DetailsLast Recertification DateUpdateRecertification9/8/2020 1:31:22 PM9/10/2021 12:45:43 PM9/10/2021 12:45 PM
ContactsPrimary ContactUpdateProfile Change RequestDe Ianni, Angela Director Supply Chain, Pharmacy Advocate Aurora Health Care 4143821854De Ianni, Angela Director Supply Chain, Pharmacy Advocate Aurora Health Care 41463015419/1/2021 1:46 PM
AddressesMain AddressUpdateChange Request 1821 S. La Grange Road Tinley Park, IL 60487 18210 S. La Grange Road Tinley Park, IL 6048710/20/2020 1:08 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:31 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3621691474749/8/2020 1:31 PM
Medicaid BillingMedicaid: StateInsertRecertification IL9/8/2020 1:31 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:31 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3621691470019/8/2020 1:31 PM
Medicaid BillingMedicaid: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:31 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3621691470659/8/2020 1:31 PM
Medicaid BillingMedicaid: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:31 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3621691470669/8/2020 1:31 PM
Medicaid BillingMedicaid: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:31 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3621691470749/8/2020 1:31 PM
Medicaid BillingMedicaid: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:31 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3621691474039/8/2020 1:31 PM
Medicaid BillingMedicaid: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/8/2020 1:31 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3621691474749/8/2020 1:31 PM
Medicaid BillingMedicaid: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/8/2020 1:31 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/8/2020 1:31 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/8/2020 1:31 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/8/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 13861880689/8/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 15083155169/8/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 15483750829/8/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification WI9/8/2020 1:31 PM
Medicaid BillingNPI: NumberInsertRecertification 19225426049/8/2020 1:31 PM
Medicaid BillingNPI: StateInsertRecertification WI9/8/2020 1:31 PM
DetailsLast Recertification DateUpdateRecertification 9/8/2020 1:31:22 PM9/8/2020 1:31 PM
ContactsAuthorizing OfficialUpdateChange RequestNelson, Nanine SVP-Finance Advocate Aurora Health Care 4142991610Nelson, Nan SVP-Finance Advocate Aurora Health Care 41429916106/17/2020 10:23 AM
ContactsPrimary ContactUpdateChange RequestDe Ianni, Angela Director Supply Chain, Pharmacy Advocate Aurora Health Care 4143821854De Ianni, Angela Director Supply Chain, Pharmacy Advocate Aurora Health Care 41438218546/3/2020 8:22 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/2/2020 11:54 AM
Medicaid BillingMedicaid: NumberInsertChange Request 3621691470013/2/2020 11:54 AM
Medicaid BillingMedicaid: StateInsertChange Request IL3/2/2020 11:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/2/2020 11:54 AM
Medicaid BillingMedicaid: NumberInsertChange Request 3621691474033/2/2020 11:54 AM
Medicaid BillingMedicaid: StateInsertChange Request IL3/2/2020 11:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/2/2020 11:54 AM
Medicaid BillingMedicaid: NumberInsertChange Request 3621691470653/2/2020 11:54 AM
Medicaid BillingMedicaid: StateInsertChange Request IL3/2/2020 11:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/2/2020 11:54 AM
Medicaid BillingMedicaid: NumberInsertChange Request 3621691470663/2/2020 11:54 AM
Medicaid BillingMedicaid: StateInsertChange Request IL3/2/2020 11:54 AM
Medicaid BillingMedicaid: Is PrimaryInsertChange Request False3/2/2020 11:54 AM
Medicaid BillingMedicaid: NumberInsertChange Request 3621691470743/2/2020 11:54 AM
Medicaid BillingMedicaid: StateInsertChange Request IL3/2/2020 11:54 AM
DetailsStateUpdate ApprovedActive1/1/2020 12:04 AM
ContactsSigned ByInsertNew Registration Nelson, Nanine SVP-Finance Advocate Aurora Health Care 414299161010/31/2019 8:33 AM
Details340B IDUpdateNew Registration DSH140208B10/31/2019 8:33 AM
DetailsEntity NameUpdateNew RegistrationADVOCATE CHRIST HOSPITALADVOCATE CHRIST MEDICAL CENTER10/31/2019 8:33 AM
DetailsEntity SubnameUpdateNew RegistrationPhysical TherapyPhysical Therapy - Tinley Park Rehab10/31/2019 8:33 AM
DatesParticipating Approval DateUpdateNew Registration 10/31/2019 8:33:15 AM10/31/2019 8:33 AM
DetailsStateUpdateNew RegistrationPendingApproved10/31/2019 8:33 AM
DatesSigned By DateUpdateNew Registration 10/9/2019 5:34:37 PM10/31/2019 8:33 AM
DatesStart DateUpdateNew Registration 1/1/2020 12:00:00 AM10/31/2019 8:33 AM
Medicaid BillingNPI: NumberInsertNew Registration 192254260410/9/2019 9:34 PM
Medicaid BillingNPI: NumberInsertNew Registration 138618806810/9/2019 9:34 PM
AddressesMain AddressInsertNew Registration  1821 S. La Grange Road Tinley Park, IL 6048710/3/2019 1:16 PM
AddressesBilling AddressInsertNew Registration Advocate Christ Medical Center 4440 W 95th Street Oak Lawn, IL 6045310/3/2019 1:16 PM
AddressesShipping AddressInsertNew Registration Advocate Christ Medical Center 4440 W 95th Street Oak Lawn, IL 6045310/3/2019 1:16 PM
AddressesShipping AddressInsertNew Registration Advocate Central Service Center 15-17 W. College Dr Arlington Heights, IL 6000410/3/2019 1:16 PM
Medicaid BillingNPI: NumberInsertNew Registration 150831551610/3/2019 1:16 PM
Medicaid BillingNPI: NumberInsertNew Registration 154837508210/3/2019 1:16 PM
ContactsPrimary ContactInsertNew Registration De Ianni, Angela Director Supply Chain, Pharmacy Advocate Aurora Health Care 414382185410/3/2019 1:16 PM
ContactsAuthorizing OfficialInsertNew Registration Nelson, Nanine SVP-Finance Advocate Aurora Health Care 414299161010/3/2019 1:16 PM
DetailsLast Recertification DateInsertNew Registration  10/3/2019 1:16 PM
DetailsGrant NumberInsertNew Registration  10/3/2019 1:16 PM
Details340B IDInsertNew Registration  10/3/2019 1:16 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  10/3/2019 1:16 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  10/3/2019 1:16 PM
DetailsMedicare Provider NumberInsertNew Registration 14020810/3/2019 1:16 PM
DetailsEntity NameInsertNew Registration ADVOCATE CHRIST HOSPITAL10/3/2019 1:16 PM
DetailsProgram CodeInsertNew Registration DSH10/3/2019 1:16 PM
DetailsEntity SubnameInsertNew Registration Physical Therapy10/3/2019 1:16 PM
DatesParticipating Approval DateInsertNew Registration  10/3/2019 1:16 PM
DetailsStateInsertNew Registration Pending10/3/2019 1:16 PM
DatesRegistration DateInsertNew Registration 10/3/2019 1:16:05 PM10/3/2019 1:16 PM
DatesSigned By DateInsertNew Registration  10/3/2019 1:16 PM
DatesStart DateInsertNew Registration  10/3/2019 1:16 PM
TerminationsTermination CommentsInsertNew Registration  10/3/2019 1:16 PM
TerminationsTermination DateInsertNew Registration  10/3/2019 1:16 PM
TerminationsTermination Effective DateInsertNew Registration  10/3/2019 1:16 PM
TerminationsTermination ReasonInsertNew Registration  10/3/2019 1:16 PM