Contacts | Primary Contact | Update | Change Request | Nowak, Jason
Director, Pharmacy 340B Program
Advocate Aurora Health
4146408457 | Nowak, Jason G
Director, Pharmacy 340B Program
Advocate Aurora Health
4146408457 | 7/22/2024 3:54 PM |
Contacts | Authorizing Official | Update | Profile Change Request | Nelson, Nan
SVP-Finance
Advocate Aurora Health Care
4142991610 | Nelson, Nan
SVP-Finance
Advocate Aurora Health Care
4143784765 | 2/7/2024 11:14 AM |
Details | State | Update | | To Be Terminated | Terminated | 10/1/2023 12:01 AM |
Dates | Last Date That 340B Drugs Purchased | Update | Termination Request | | 9/30/2023 12:00:00 AM | 7/13/2023 7:18 AM |
Details | State | Update | Termination Request | Active | To Be Terminated | 7/13/2023 7:18 AM |
Terminations | Termination Date | Update | Termination Request | | 10/1/2023 12:00:00 AM | 7/13/2023 7:18 AM |
Terminations | Termination Effective Date | Update | Termination Request | | 9/30/2023 12:00:00 AM | 7/13/2023 7:18 AM |
Terminations | Termination Reason | Update | Termination Request | | Business decision by the Covered Entity | 7/13/2023 7:18 AM |
Details | Last Recertification Date | Update | Recertification | 9/10/2021 12:45:43 PM | 9/2/2022 12:13:58 PM | 9/2/2022 12:13 PM |
Contacts | Primary Contact | Update | Group Change Request | De Ianni, Angela
Vice President Pharmacy Supply Chain
Advocate Aurora Health Care
4146301541 | Nowak, Jason
Director, Pharmacy 340B Program
Advocate Aurora Health
4146408457 | 5/4/2022 11:16 AM |
Contacts | Primary Contact | Update | Profile Change Request | De Ianni, Angela
Director Supply Chain, Pharmacy
Advocate Aurora Health Care
4146301541 | De Ianni, Angela
Vice President Pharmacy Supply Chain
Advocate Aurora Health Care
4146301541 | 10/7/2021 12:57 PM |
Details | Last Recertification Date | Update | Recertification | 9/8/2020 1:31:22 PM | 9/10/2021 12:45:43 PM | 9/10/2021 12:45 PM |
Contacts | Primary Contact | Update | Profile Change Request | De Ianni, Angela
Director Supply Chain, Pharmacy
Advocate Aurora Health Care
4143821854 | De Ianni, Angela
Director Supply Chain, Pharmacy
Advocate Aurora Health Care
4146301541 | 9/1/2021 1:46 PM |
Addresses | Main Address | Update | Change Request |
1821 S. La Grange Road
Tinley Park, IL 60487 |
18210 S. La Grange Road
Tinley Park, IL 60487 | 10/20/2020 1:08 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 362169147474 | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | IL | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 362169147001 | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 362169147065 | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 362169147066 | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 362169147074 | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 362169147403 | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 362169147474 | 9/8/2020 1:31 PM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: State | Update | Recertification | | IL | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: State | Update | Recertification | | IL | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: State | Update | Recertification | | IL | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: State | Update | Recertification | | IL | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1386188068 | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1508315516 | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1548375082 | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1922542604 | 9/8/2020 1:31 PM |
Medicaid Billing | NPI: State | Insert | Recertification | | WI | 9/8/2020 1:31 PM |
Details | Last Recertification Date | Update | Recertification | | 9/8/2020 1:31:22 PM | 9/8/2020 1:31 PM |
Contacts | Authorizing Official | Update | Change Request | Nelson, Nanine
SVP-Finance
Advocate Aurora Health Care
4142991610 | Nelson, Nan
SVP-Finance
Advocate Aurora Health Care
4142991610 | 6/17/2020 10:23 AM |
Contacts | Primary Contact | Update | Change Request | De Ianni, Angela
Director Supply Chain, Pharmacy
Advocate Aurora Health Care
4143821854 | De Ianni, Angela
Director Supply Chain, Pharmacy
Advocate Aurora Health Care
4143821854 | 6/3/2020 8:22 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 362169147001 | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | IL | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 362169147403 | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | IL | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 362169147065 | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | IL | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 362169147066 | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | IL | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: Number | Insert | Change Request | | 362169147074 | 3/2/2020 11:54 AM |
Medicaid Billing | Medicaid: State | Insert | Change Request | | IL | 3/2/2020 11:54 AM |
Details | State | Update | | Approved | Active | 1/1/2020 12:04 AM |
Contacts | Signed By | Insert | New Registration | | Nelson, Nanine
SVP-Finance
Advocate Aurora Health Care
4142991610 | 10/31/2019 8:33 AM |
Details | 340B ID | Update | New Registration | | DSH140208B | 10/31/2019 8:33 AM |
Details | Entity Name | Update | New Registration | ADVOCATE CHRIST HOSPITAL | ADVOCATE CHRIST MEDICAL CENTER | 10/31/2019 8:33 AM |
Details | Entity Subname | Update | New Registration | Physical Therapy | Physical Therapy - Tinley Park Rehab | 10/31/2019 8:33 AM |
Dates | Participating Approval Date | Update | New Registration | | 10/31/2019 8:33:15 AM | 10/31/2019 8:33 AM |
Details | State | Update | New Registration | Pending | Approved | 10/31/2019 8:33 AM |
Dates | Signed By Date | Update | New Registration | | 10/9/2019 5:34:37 PM | 10/31/2019 8:33 AM |
Dates | Start Date | Update | New Registration | | 1/1/2020 12:00:00 AM | 10/31/2019 8:33 AM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1922542604 | 10/9/2019 9:34 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1386188068 | 10/9/2019 9:34 PM |
Addresses | Main Address | Insert | New Registration | |
1821 S. La Grange Road
Tinley Park, IL 60487 | 10/3/2019 1:16 PM |
Addresses | Billing Address | Insert | New Registration | | Advocate Christ Medical Center
4440 W 95th Street
Oak Lawn, IL 60453 | 10/3/2019 1:16 PM |
Addresses | Shipping Address | Insert | New Registration | | Advocate Christ Medical Center
4440 W 95th Street
Oak Lawn, IL 60453 | 10/3/2019 1:16 PM |
Addresses | Shipping Address | Insert | New Registration | | Advocate Central Service Center
15-17 W. College Dr
Arlington Heights, IL 60004 | 10/3/2019 1:16 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1508315516 | 10/3/2019 1:16 PM |
Medicaid Billing | NPI: Number | Insert | New Registration | | 1548375082 | 10/3/2019 1:16 PM |
Contacts | Primary Contact | Insert | New Registration | | De Ianni, Angela
Director Supply Chain, Pharmacy
Advocate Aurora Health Care
4143821854 | 10/3/2019 1:16 PM |
Contacts | Authorizing Official | Insert | New Registration | | Nelson, Nanine
SVP-Finance
Advocate Aurora Health Care
4142991610 | 10/3/2019 1:16 PM |
Details | Last Recertification Date | Insert | New Registration | | | 10/3/2019 1:16 PM |
Details | Grant Number | Insert | New Registration | | | 10/3/2019 1:16 PM |
Details | 340B ID | Insert | New Registration | | | 10/3/2019 1:16 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 10/3/2019 1:16 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 10/3/2019 1:16 PM |
Details | Medicare Provider Number | Insert | New Registration | | 140208 | 10/3/2019 1:16 PM |
Details | Entity Name | Insert | New Registration | | ADVOCATE CHRIST HOSPITAL | 10/3/2019 1:16 PM |
Details | Program Code | Insert | New Registration | | DSH | 10/3/2019 1:16 PM |
Details | Entity Subname | Insert | New Registration | | Physical Therapy | 10/3/2019 1:16 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 10/3/2019 1:16 PM |
Details | State | Insert | New Registration | | Pending | 10/3/2019 1:16 PM |
Dates | Registration Date | Insert | New Registration | | 10/3/2019 1:16:05 PM | 10/3/2019 1:16 PM |
Dates | Signed By Date | Insert | New Registration | | | 10/3/2019 1:16 PM |
Dates | Start Date | Insert | New Registration | | | 10/3/2019 1:16 PM |
Terminations | Termination Comments | Insert | New Registration | | | 10/3/2019 1:16 PM |
Terminations | Termination Date | Insert | New Registration | | | 10/3/2019 1:16 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 10/3/2019 1:16 PM |
Terminations | Termination Reason | Insert | New Registration | | | 10/3/2019 1:16 PM |