340B Drug Pricing Program Database
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DSH140304L UChicago Medicine AdventHealth Bolingbrook (Active)
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Main Details
Name
UChicago Medicine AdventHealth Bolingbrook
Subdivision Name
UChicago Medicine AdventHealth Bariatric Surgery Center Bolingbrook - Bariatric Surgery Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140304L
Medicare Provider Number
140304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/8/2024
Participating Start Date
1/1/2025
Participating Approval Date
10/10/2024
Last Recertification Date
Contacts
Authorizing Official
UChicago Medicine AdventHealth Bolingbrook
Tristan R Shaw, CFO
(630) 312-6008
Primary Contact
UChicago Medicine AdventHealth Bolingbrook
DAVID TSANG, 340B PROGRAM DIRECTOR
(847) 372-8408
Addresses
Street Address
420 S Schmidt Road
Suite 235
Bolingbrook, IL 60440
Billing Address
UChicago Medicine AdventHealth Bolingbrook
c/o AdventHealth
902 Inspiration Avenue
Suite 9100
Altamonte Springs, FL 32714
Comments
Medicaid Billing
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Contract Pharmacies
Parent/Child
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