Covered Entity Details

DSH140124AK JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY (Active) - information as of 5/7/2025 10:39:45 PM

Main Details

Name

JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY

Subdivision Name

Professional Building - Hematology Clinic - Clinical Hematology

Type

Disproportionate Share Hospital

Rural

340B ID

DSH140124AK

Medicare Provider Number

140124

Outpatient Facility Provider Number

Additional Details

Current Program Status

Active

Registration Date

10/14/2022

Participating Start Date

1/1/2023

Participating Approval Date

10/28/2022

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

1950 West Polk Street
Chicago, IL 60612

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	366006541043,366006541073,366006541606	1245350040,1588612832,1821385170
IN	300057924,300062812,300058011	1518598507,1588612832,1790316784

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	10/11/2023	01/01/2024			01/01/2024

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
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	3/12/2025 1:06 PM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		300058011	3/12/2025 1:06 PM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IN	3/12/2025 1:06 PM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1790316784	3/12/2025 1:06 PM
Medicaid Billing	NPI: State	Insert	Group Change Request		IN	3/12/2025 1:06 PM
Details	Last Recertification Date	Update	Recertification	9/5/2023 4:05:39 PM	8/15/2024 1:29:49 PM	8/15/2024 1:29 PM
Details	Last Recertification Date	Update	Recertification		9/5/2023 4:05:39 PM	9/5/2023 4:05 PM
Details	State	Update		Approved	Active	1/1/2023 12:01 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	12/27/2022 8:29 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		366006541073	12/27/2022 8:29 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IL	12/27/2022 8:29 AM
Medicaid Billing	Medicaid: Is Primary	Insert	Group Change Request		False	12/27/2022 8:29 AM
Medicaid Billing	Medicaid: Number	Insert	Group Change Request		366006541606	12/27/2022 8:29 AM
Medicaid Billing	Medicaid: State	Insert	Group Change Request		IL	12/27/2022 8:29 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1588612832	12/27/2022 8:29 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	12/27/2022 8:29 AM
Medicaid Billing	NPI: Number	Insert	Group Change Request		1821385170	12/27/2022 8:29 AM
Medicaid Billing	NPI: State	Insert	Group Change Request		IL	12/27/2022 8:29 AM
Contacts	Signed By	Insert	New Registration		Cassara, Pamela Chief Financial Officer Cook County Health 3128645507	10/28/2022 8:58 AM
Details	340B ID	Update	New Registration		DSH140124AK	10/28/2022 8:58 AM
Details	Entity Name	Update	New Registration	JOHN H. STROGER JR. HOSP OF COOK CTY	JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY	10/28/2022 8:58 AM
Details	Entity Subname	Update	New Registration	Professional Building - Hematology Clinic	Professional Building - Hematology Clinic - Clinical Hematology	10/28/2022 8:58 AM
Dates	Participating Approval Date	Update	New Registration		10/28/2022 8:58:11 AM	10/28/2022 8:58 AM
Details	State	Update	New Registration	Pending	Approved	10/28/2022 8:58 AM
Dates	Signed By Date	Update	New Registration		10/26/2022 11:36:29 AM	10/28/2022 8:58 AM
Dates	Start Date	Update	New Registration		1/1/2023 12:00:00 AM	10/28/2022 8:58 AM
Addresses	Main Address	Insert	New Registration		1950 West Polk Street Chicago, IL 60612	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		366006541043	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		300057924	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		300062812	10/14/2022 12:07 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IN	10/14/2022 12:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1245350040	10/14/2022 12:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	10/14/2022 12:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1518598507	10/14/2022 12:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		IN	10/14/2022 12:07 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1588612832	10/14/2022 12:07 PM
Medicaid Billing	NPI: State	Insert	New Registration		IN	10/14/2022 12:07 PM
Contacts	Primary Contact	Insert	New Registration		Norwood, CaTanya Senior Director of Pharmacy Cook County Health & Hospitals System 3128642213	10/14/2022 12:07 PM
Contacts	Authorizing Official	Insert	New Registration		Cassara, Pamela Chief Financial Officer Cook County Health 3128645507	10/14/2022 12:07 PM
Details	Assistance Received From Date	Insert	New Registration			10/14/2022 12:07 PM
Details	Assistance Received To Date	Insert	New Registration			10/14/2022 12:07 PM
Details	Last Recertification Date	Insert	New Registration			10/14/2022 12:07 PM
Details	Grant Number	Insert	New Registration			10/14/2022 12:07 PM
Details	340B ID	Insert	New Registration			10/14/2022 12:07 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			10/14/2022 12:07 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			10/14/2022 12:07 PM
Details	Medicare Provider Number	Insert	New Registration		140124	10/14/2022 12:07 PM
Details	Entity Name	Insert	New Registration		JOHN H. STROGER JR. HOSP OF COOK CTY	10/14/2022 12:07 PM
Details	NOFO Number	Insert	New Registration			10/14/2022 12:07 PM
Details	Program Code	Insert	New Registration		DSH	10/14/2022 12:07 PM
Details	Entity Subname	Insert	New Registration		Professional Building - Hematology Clinic	10/14/2022 12:07 PM
Dates	Participating Approval Date	Insert	New Registration			10/14/2022 12:07 PM
Details	State	Insert	New Registration		Pending	10/14/2022 12:07 PM
Dates	Registration Date	Insert	New Registration		10/14/2022 12:07:03 PM	10/14/2022 12:07 PM
Dates	Signed By Date	Insert	New Registration			10/14/2022 12:07 PM
Dates	Start Date	Insert	New Registration			10/14/2022 12:07 PM
Terminations	Termination Comments	Insert	New Registration			10/14/2022 12:07 PM
Terminations	Termination Date	Insert	New Registration			10/14/2022 12:07 PM
Terminations	Termination Effective Date	Insert	New Registration			10/14/2022 12:07 PM
Terminations	Termination Reason	Insert	New Registration			10/14/2022 12:07 PM