340B Drug Pricing Program Database


RRC140281-00 NORTHWESTERN MEMORIAL HOSPITAL (Active) - information as of 6/17/2025 11:44:34 PM

Main Details
NORTHWESTERN MEMORIAL HOSPITAL
Rural Referral Center
Yes
RRC140281-00
140281


Additional Details
Active
7/15/2020
8/7/2020
7/31/2020
8/27/2024

Contacts

Northwestern Memorial Hospital
Matthew Joseph Flynn, VP, Finance, NMHC
(312) 926-5236

Northwestern Memorial Hospital
Richard Jacobson, Director of Pharmacy
(312) 926-3024

Addresses

251 E HURON
CHICAGO, IL 60611

Northwestern Memorial Healthcare
Accounts Payable - PO Box 13776
Philadelphia, PA 19101-3776


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

Yes
StateMedicaid NumberNPI Number
IL3709601700011497859649,1831298926,1902238645
Shipping Addresses

NORTHWESTERN MEM HOSP SPEC LC704 STORE ROM
251 E HURON ST LC 704
Chicago, IL 60611-3232

Northwestern Medicine Specialty Pharmacy
676 N St Clair St Suite 560
Chicago, IL 60611

Northwestern Memorial Hospital - Cell Therapy Lab
710 N Fairbanks Court
Olson 7-613
Chicago, IL 60611

Northwestern Memorial Hospital - Galter 17 Pharmacy
675 N St Clair Street
#17-111
Chicago, IL 60611
Contract Pharmacies
Contract DetailPharmacy NameAddressAddress Cont.CityStateZip CodeApproval DateBegin DateCarve-In Effective DateTermination DateLast Updated On
Contract DetailACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/14/202110/01/2021  10/01/2021
Contract DetailACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/14/202310/01/2023  10/01/2023
Contract DetailACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/14/202310/01/2023  10/01/2023
Contract DetailACCREDO HEALTH GROUP, INC.2825 W PERIMETER RD STE 112
INDIANAPOLISIN4624107/14/202110/01/2021 07/01/202310/13/2023
Contract DetailACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607501/14/202204/01/2022  04/01/2022
Contract DetailACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/14/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526107/17/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771307/17/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267007/17/202310/01/2023  10/01/2023
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620301/15/202504/01/2025  04/01/2025
Contract DetailBIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522601/15/202504/01/2025  04/01/2025
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03698 3201 N. BROADWAY ST.
CHICAGOIL6065710/12/202001/01/2021  01/01/2021
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA WALGREENS SPECIALTY PHARMACY #04505 4025 N. SHERIDAN RD.
CHICAGOIL6061310/12/202001/01/2021  01/01/2021
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04978 111 S. HALSTED STREET
CHICAGOIL6066110/11/202101/01/2022  01/01/2022
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04461 501 W ROOSEVELT RD
CHICAGOIL6060710/11/202101/01/2022  01/01/2022
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03072 641 N CLARK ST
CHICAGOIL6065410/11/202101/01/2022  01/01/2022
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02877 2440 W NORTH AVE
CHICAGOIL6064701/14/202204/01/2022  04/01/2022
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04494 1649 W. BELMONT AVENUE
CHICAGOIL6065701/14/202204/01/2022  04/01/2022
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01298 1372 N MILWAUKEE AVE
CHICAGOIL6062201/10/202304/01/2023  04/01/2023
Contract DetailBOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS #15921 410 N MICHIGAN AVE
CHICAGOIL6061104/12/202407/01/2024  07/01/2024
Contract DetailCAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361407/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005607/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621907/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175707/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808307/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700407/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761707/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107 		BARTLETTTN3813307/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A 		REDLANDSCA9237407/15/202207/26/2022  07/26/2022
Contract DetailCAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911907/15/202207/26/2022  07/26/2022
Contract DetailCENTRAL DUPAGE SPECIAL HEALTH ASSOCIATIODBA CNS HOME INFUSION & PHARMACY 26W171 ROOSEVELT RD RM G021
WHEATONIL60187-600207/14/202310/01/2023  10/01/2023
Contract DetailCVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870608/04/202208/08/2022  08/08/2022
Contract DetailCVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005608/04/202208/08/2022  08/08/2022
Contract DetailCVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502807/15/202207/26/2022  07/26/2022
Contract DetailCYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503310/12/202001/01/2021  01/01/2021
Contract DetailDIPLOMAT SPECIALTY PHARMACY4100 S SAGINAW ST STE D
FLINTMI48507-268304/15/202107/01/2021 04/12/202404/12/2024
Contract DetailDOGWOOD PHARMACY LLCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER RD
STE K 		GREENVILLESC29607-654107/17/202310/01/2023  10/01/2023
Contract DetailESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/14/202110/01/2021  10/01/2021
Contract DetailEXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/14/202110/01/2021  10/01/2021
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/14/202110/01/2021  10/01/2021
Contract DetailEXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/14/202110/01/2021  10/01/2021
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02942 401 W. ARMITAGE AVE.
CHICAGOIL6061407/15/202207/26/2022 01/23/202404/12/2024
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02981 1201 N. STATE ST.
CHICAGOIL6061007/15/202207/26/2022  07/26/2022
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05001 3033 N. BROADWAY ST.
CHICAGOIL6065707/15/202207/26/2022  07/26/2022
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05836 1228 E. 53RD ST.
CHICAGOIL6061507/15/202207/26/2022  07/26/2022
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08698 1165 N. CLARK
CHICAGOIL6061007/15/202207/26/2022  07/26/2022
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08910 205 N COLUMBUS DR
CHICAGOIL6060107/15/202207/26/2022  07/26/2022
Contract DetailHIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17677 401 E ILLINOIS ST
CHICAGOIL6061107/15/202207/26/2022 02/20/202404/12/2024
Contract DetailHIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 11090 670-678 N WELLS ST
CHICAGOIL6065404/03/202307/01/2023  07/01/2023
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 00788 344 WEST HUBBARD
CHICAGOIL6065407/14/202310/01/2023  10/01/2023
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 01493 5205 N. BROADWAY ST.
CHICAGOIL6064007/14/202310/01/2023  10/01/2023
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 03742 121 W KINZIE ST
CHICAGOIL6065407/14/202310/01/2023  10/01/2023
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08735 3940 WEST FULLERTON
CHICAGOIL6064707/14/202310/01/2023  10/01/2023
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA CVS/PHARMACY #11410 25 EAST OHIO STREET
CHICAGOIL6061101/12/202404/01/2024  04/01/2024
Contract DetailHIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17437 4466 N BROADWAY ST
CHICAGOIL6064001/12/202404/01/2024  04/01/2024
Contract DetailHIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 04781 205 N. MICHIGAN AVE.
CHICAGOIL6060104/12/202407/01/2024  07/01/2024
Contract DetailOPTUM PHARMACY 700, LLC5700 DOT COM CT, STE 1000
OVIEDOFL3276504/15/202107/01/2021 07/23/202407/23/2024
Contract DetailOPTUM PHARMACY 701, LLC8131 W BOSTIAN RD STE A350
WOODINVILLEWA98072-502904/15/202107/01/2021 07/23/202407/23/2024
Contract DetailOPTUM PHARMACY 701, LLC4100 S SAGINAW ST STE D
FLINTMI4850704/11/202204/15/2022  04/21/2022
Contract DetailOPTUM PHARMACY 702, LLC1050 PATROL RD
JEFFERSONVILLEIN4713004/15/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 704, INC.5627 UNIVERSITY HTS STE 108
SAN ANTONIOTX7824904/15/202107/01/2021 07/23/202407/23/2024
Contract DetailOPTUM PHARMACY 705, LLC11142 RENNER BLVD
LENEXAKS6621904/15/202107/01/2021 08/24/202108/30/2021
Contract DetailOPTUM PHARMACY 705, LLC1100 LEE BRANCH LN
BIRMINGHAMAL35242-729804/15/202107/01/2021  07/01/2021
Contract DetailOPTUM PHARMACY 801, INC.24416 N 19TH AVE STE. 100
PHOENIXAZ8508504/15/202107/01/2021 07/23/202407/23/2024
Contract DetailOPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983810/15/202101/01/2022 07/23/202407/23/2024
Contract DetailPRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100 		ORLANDOFL32819-999210/12/202001/01/2021 10/13/202310/13/2023
Contract DetailPROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514607/15/202207/26/2022  07/26/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523307/15/202207/26/2022  07/26/2022
Contract DetailPROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920307/15/202207/26/2022  07/26/2022
Contract DetailRAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103 		NEWBURGHNY1255007/17/202310/01/2023  10/01/2023
Contract DetailRIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500207/17/202310/01/2023  10/01/2023
Contract DetailSANTA BARBARA SPECIALTY PHARMACY LLC4690 CARPINTERIA AVE STE B
CARPINTERIACA9301307/17/202310/01/2023  10/01/2023
Contract DetailSHEFFIELD AVENUE CVS, L.L.C.DBA: CVS/PHARMACY # 03690 1714 N. SHEFFIELD AVE.
CHICAGOIL6061407/15/202207/26/2022  07/26/2022
Contract DetailWALGREEN CODBA: WALGREENS #15525 201 E. HURON STREET, SUITE 01-210
CHICAGOIL6061110/12/202001/01/2021  01/01/2021
Contract DetailWalgreen CODBA Walgreens Central Fill #21417 599 S Schmidt Rd
Ste A 		BolingbrookIL60440-940501/10/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 00162 1554 E 55TH ST
CHICAGOIL6061510/12/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 00211 757 N MICHIGAN AVE
CHICAGOIL6061110/12/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 09000 2001 N MILWAUKEE AVE
CHICAGOIL60647-400110/12/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS #13975 711 W NORTH AVE STE #204
CHICAGOIL6061010/12/202001/01/2021 09/18/202309/18/2023
Contract DetailWALGREEN CO.WALGREENS SPECIALTY PHARMACY #15305 912 W BELMONT AVE
CHICAGOIL6065710/12/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS #15493 1333 W. BELMONT AVENUE
CHICAGOIL6065710/12/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA WALGREENS #15971 259 E. ERIE STREET
SUITE 250 		CHICAGOIL6061110/12/202001/01/2021  01/01/2021
Contract DetailWALGREEN CO.DBA: WALGREENS # 00249 1601 N WELLS
CHICAGOIL6061410/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 07630 933 N STATE STREET
CHICAGOIL60610-284210/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 01375 1200 N DEARBORN ST
CHICAGOIL60610-834110/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 02340 342 E ILLINOIS ST
CHICAGOIL60611-430410/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #15992 2500 N CLARK ST
CHICAGOIL6061410/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 00178 740 W DIVERSEY PKWY
CHICAGOIL6061410/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY#16501 6500 N CLARK ST
SUITE 101 		CHICAGOIL6062610/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #21447 3513 N HALSTED ST
CHICAGOIL6065710/11/202101/01/2022  01/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 00258 1650 W CHICAGO AVE
CHICAGOIL6062201/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 01173 1520 W FULLERTON
CHICAGOIL6061401/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS # 01096 3646 N BROADWAY
CHICAGOIL6061301/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #15004 953 W. IRVING PARK RD.
CHICAGOIL6061301/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #15350 834 W. ARMITAGE AVENUE
CHICAGOIL6061401/14/202204/01/2022  04/01/2022
Contract DetailWALGREEN CO.DBA: WALGREENS #15065 1601 N. MILWAUKEE AVE.
CHICAGOIL60647-541101/14/202204/01/2022 01/31/202302/08/2023
Contract DetailWALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #09399 2835 N SHEFFIELD AVE STE 505
CHICAGOIL6065704/11/202207/01/2022  07/01/2022
Contract DetailWALGREEN CO.DBA: PARKWAY DRUGS, A WALGREENS PHARMACY 680 N LAKE SHORE DR
SUITE 108 		CHICAGOIL6061101/10/202304/01/2023 11/16/202304/12/2024
Contract DetailWALGREEN CO.DBA: WALGREENS #15196 151 N. STATE ST.
CHICAGOIL60601-360101/10/202304/01/2023  04/01/2023
Contract DetailWALGREEN CO.DBA: WALGREENS # 07179 2 E ROOSEVELT RD
CHICAGOIL60605-241004/02/202507/01/2025  04/02/2025
Contract DetailWALGREENS MAIL SERVICE, LLCWALGREENS MAIL SERVICE #03397 8350 S RIVER PARKWAY
TEMPEAZ8528410/12/202001/01/2021  01/01/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700810/12/202001/01/2021 10/01/202110/25/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818810/12/202001/01/2021  01/01/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503310/12/202001/01/2021  01/01/2021
Contract DetailWALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527510/12/202001/01/2021  01/01/2021
Contract DetailWALGREENS.COM, INC.DBA: WALGREENS 2225 S. PRICE ROAD
CHANDLERAZ8528610/12/202001/01/2021  01/01/2021
Parent/Child
340B IDHierarchyEntity TypeNameSub NameAddressCityState340B Status
RRC140281-02ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - NMH Cardiac Rehab1030 N CLARK STCHICAGOILActive
RRC140281-03ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - NMH Lakeview Radiology-Diagnostic1333 W BELMONT AVECHICAGOILTerminated
RRC140281-05ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - NMH Bucktown - Radiology-Diagnostic1776 N MILWAUKEE AVECHICAGOILTerminated
RRC140281-06ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Prentice Operating Room250 E SUPERIOR STCHICAGOILActive
RRC140281-07ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Prentice Delivery Room & Labor Room250 E SUPERIOR STCHICAGOILActive
RRC140281-08ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Prentice MRI250 E SUPERIOR STCHICAGOILTerminated
RRC140281-09ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Prentice Recovery Room250 E SUPERIOR STCHICAGOILActive
RRC140281-10ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Prentice Anesthesiology250 E SUPERIOR STCHICAGOILActive
RRC140281-11ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Prentice Laboratory250 E SUPERIOR STCHICAGOILTerminated
RRC140281-12ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Prentice Radiology-Diagnostic250 E SUPERIOR STCHICAGOILTerminated
RRC140281-13ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Prentice Radiology-Therapeutic250 E SUPERIOR STCHICAGOILTerminated
RRC140281-14ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion Laboratory259 E ERIE STCHICAGOILTerminated
RRC140281-15ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion Radiology-Diagnostic259 E ERIE STCHICAGOILTerminated
RRC140281-16ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion Recovery Room259 E ERIE STCHICAGOILActive
RRC140281-17ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion Non-Invasive Cardiac Testing259 E ERIE STCHICAGOILActive
RRC140281-18ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion Operating Room259 E ERIE STCHICAGOILActive
RRC140281-19ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion CT Scan259 E ERIE STCHICAGOILTerminated
RRC140281-20ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion MRI259 E ERIE STCHICAGOILTerminated
RRC140281-21ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion Anesthesiology259 E ERIE STCHICAGOILActive
RRC140281-22ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion GI259 E ERIE STCHICAGOILActive
RRC140281-23ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Pavilion Pain Clinic259 East Erie StreetChicagoILActive
RRC140281-24ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Pavilion PreOp Clinic259 East Erie StreetChicagoILActive
RRC140281-25ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Lavin Pavilion Digestive Health Clinic259 East Erie StreetChicagoILActive
RRC140281-26ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Arkes Pavilion Radiology-Diagnostic676 N SAINT CLAIR STCHICAGOILTerminated
RRC140281-27ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Arkes Pavilion Radioisotope676 N SAINT CLAIR STCHICAGOILTerminated
RRC140281-28ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Arkes Pavilion CT Scan676 N SAINT CLAIR STCHICAGOILTerminated
RRC140281-29ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Arkes Pavilion MRI676 N SAINT CLAIR STCHICAGOILTerminated
RRC140281-30ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Arkes Pavilion Laboratory676 N SAINT CLAIR STCHICAGOILTerminated
RRC140281-31ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Arkes Pavilion Transplant Clinic676 North St. Clair StreetChicagoILActive
RRC140281-32ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Arkes Pavilion Infectious Disease Clinic676 North St. Clair StreetChicagoILActive
RRC140281-33ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Olson Pavilion Laboratory710 N FAIRBANKS CTCHICAGOILTerminated
RRC140281-34ChildRRCNORTHWESTERN MEMORIAL HOSPITALNORTHWESTERN MEMORIAL HOSPITAL - Olson Pavilion Radiology-Therapeutic710 N FAIRBANKS CTCHICAGOILTerminated
RRC140281-35ChildRRCNORTHWESTERN MEMORIAL HOSPITALNorthwestern Memorial Hospital Galter Interventional GI - Galter Interventional GI675 N Saint Clair StChicagoILActive
RRC140281-36ChildRRCNORTHWESTERN MEMORIAL HOSPITALNorthwestern Memorial Hospital NMH Rube Walker - NMH Rube Walker250 E Superior StreetChicagoILActive
RRC140281-37ChildRRCNORTHWESTERN MEMORIAL HOSPITALNorthwestern Memorial Hospital NMH Developmental Therapeutics - NMH Developmental Therapeutics233 E Superior StChicagoILActive
RRC140281-38ChildRRCNORTHWESTERN MEMORIAL HOSPITALNorthwestern Memorial Hospital Galter GI Post-Op Recovery - Galter GI Post-Op Recovery675 N Saint Clair StChicagoILActive
RRC140281-39ChildRRCNORTHWESTERN MEMORIAL HOSPITALMedicine Therapy Management - Medication Therapy Management676 N St Clair StChicagoILActive
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
AddressesShipping AddressInsertChange Request Northwestern Memorial Hospital - Galter 17 Pharmacy 675 N St Clair Street #17-111 Chicago, IL 606116/10/2025 2:27 PM
DetailsLast Recertification DateUpdateRecertification8/21/2023 1:24:28 PM8/27/2024 2:07:23 PM8/27/2024 2:07 PM
ContactsAuthorizing OfficialUpdateProfile Change RequestFlynn, Matthew Joseph Chief Financial Officer Northwestern Memorial Hospital 3129265236Flynn, Matthew Joseph VP, Finance, NMHC Northwestern Memorial Hospital 312926523611/15/2023 1:08 PM
DetailsLast Recertification DateUpdateRecertification9/8/2022 11:58:11 AM8/21/2023 1:24:28 PM8/21/2023 1:24 PM
AddressesBilling AddressInsertGroup Change Request Northwestern Memorial Healthcare Accounts Payable - PO Box 13776 Philadelphia, PA 19101-37761/10/2023 1:54 PM
ContactsAuthorizing OfficialUpdateAO Change RequestFraher, Francis Donald CFO Northwestern Memorial Hospital 3129265236Flynn, Matthew Joseph Chief Financial Officer Northwestern Memorial Hospital 312926523612/15/2022 4:31 PM
DetailsLast Recertification DateUpdateRecertification8/30/2021 2:03:24 PM9/8/2022 11:58:11 AM9/8/2022 11:58 AM
AddressesShipping AddressInsertChange Request Northwestern Memorial Hospital - Cell Therapy Lab 710 N Fairbanks Court Olson 7-613 Chicago, IL 606113/14/2022 9:26 AM
DetailsLast Recertification DateUpdateRecertification9/11/2020 2:24:45 PM8/30/2021 2:03:24 PM8/30/2021 2:03 PM
AddressesShipping AddressInsertChange Request NORTHWESTERN MEM HOSP SPEC LC704 STORE ROM 251 E HURON ST LC 704 Chicago, IL 60611-32323/22/2021 8:47 AM
AddressesShipping AddressInsertChange Request Northwestern Medicine Specialty Pharmacy 676 N St Clair St Suite 560 Chicago, IL 606113/22/2021 8:47 AM
Medicaid BillingNPI: NumberInsertChange Request 19022386453/22/2021 8:47 AM
Medicaid BillingNPI: StateInsertChange Request IL3/22/2021 8:47 AM
AddressesMain AddressUpdateRecertification 251E HURON CHICAGO, IL 60611 251 E HURON CHICAGO, IL 606119/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertification300031230 (IN) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertification80489200 (WI) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertification1011906 (WA) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertification358232 (OH) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertificationQ44890 (TN) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertification11631207 (MO) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertification7001572810 (KY) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertification9000170376 (CO) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberDeleteRecertification930458 (FL) 9/11/2020 2:24 PM
Medicaid BillingMedicaid: Is PrimaryInsertRecertification False9/11/2020 2:24 PM
Medicaid BillingMedicaid: NumberInsertRecertification 3709601700019/11/2020 2:24 PM
Medicaid BillingMedicaid: StateInsertRecertification IL9/11/2020 2:24 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/11/2020 2:24 PM
Medicaid BillingNPI: StateUpdateRecertification IL9/11/2020 2:24 PM
DetailsLast Recertification DateUpdateRecertification 9/11/2020 2:24:45 PM9/11/2020 2:24 PM
DetailsStateUpdateOPA EditApprovedActive8/7/2020 6:29 AM
DatesStart DateUpdateOPA Edit10/1/2020 12:00:00 AM8/7/2020 12:00:00 AM8/7/2020 6:29 AM
ContactsSigned ByInsertNew Registration Fraher, Francis Donald CFO Northwestern Memorial Hospital 31292652367/31/2020 11:19 AM
Details340B IDUpdateNew Registration RRC140281-007/31/2020 11:19 AM
DatesParticipating Approval DateUpdateNew Registration 7/31/2020 11:19:43 AM7/31/2020 11:19 AM
DetailsStateUpdateNew RegistrationPendingApproved7/31/2020 11:19 AM
DatesSigned By DateUpdateNew Registration 7/30/2020 5:08:39 PM7/31/2020 11:19 AM
DatesStart DateUpdateNew Registration 10/1/2020 12:00:00 AM7/31/2020 11:19 AM
AddressesMain AddressInsertNew Registration  251E HURON CHICAGO, IL 606117/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 3000312307/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration IN7/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 804892007/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration WI7/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 10119067/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration WA7/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 3582327/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration OH7/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration Q448907/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration TN7/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 116312077/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration MO7/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 70015728107/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration KY7/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 90001703767/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration CO7/15/2020 2:46 PM
Medicaid BillingMedicaid: Is PrimaryInsertNew Registration False7/15/2020 2:46 PM
Medicaid BillingMedicaid: NumberInsertNew Registration 9304587/15/2020 2:46 PM
Medicaid BillingMedicaid: StateInsertNew Registration FL7/15/2020 2:46 PM
Medicaid BillingNPI: NumberInsertNew Registration 14978596497/15/2020 2:46 PM
Medicaid BillingNPI: NumberInsertNew Registration 18312989267/15/2020 2:46 PM
ContactsAuthorizing OfficialInsertNew Registration Fraher, Francis Donald CFO Northwestern Memorial Hospital 31292652367/15/2020 2:46 PM
ContactsPrimary ContactInsertNew Registration Jacobson, Richard Director of Pharmacy Northwestern Memorial Hospital 31292630247/15/2020 2:46 PM
DetailsLast Recertification DateInsertNew Registration  7/15/2020 2:46 PM
DetailsGrant NumberInsertNew Registration  7/15/2020 2:46 PM
Details340B IDInsertNew Registration  7/15/2020 2:46 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/15/2020 2:46 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/15/2020 2:46 PM
DetailsMedicare Provider NumberInsertNew Registration 1402817/15/2020 2:46 PM
DetailsEntity NameInsertNew Registration NORTHWESTERN MEMORIAL HOSPITAL7/15/2020 2:46 PM
DetailsProgram CodeInsertNew Registration RRC7/15/2020 2:46 PM
DetailsEntity SubnameInsertNew Registration  7/15/2020 2:46 PM
DatesParticipating Approval DateInsertNew Registration  7/15/2020 2:46 PM
DetailsStateInsertNew Registration Pending7/15/2020 2:46 PM
DatesRegistration DateInsertNew Registration 7/15/2020 2:46:52 PM7/15/2020 2:46 PM
DatesSigned By DateInsertNew Registration  7/15/2020 2:46 PM
DatesStart DateInsertNew Registration  7/15/2020 2:46 PM
TerminationsTermination CommentsInsertNew Registration  7/15/2020 2:46 PM
TerminationsTermination DateInsertNew Registration  7/15/2020 2:46 PM
TerminationsTermination Effective DateInsertNew Registration  7/15/2020 2:46 PM
TerminationsTermination ReasonInsertNew Registration  7/15/2020 2:46 PM