340B Drug Pricing Program Database
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DSH140182X ADVOCATE NORTH SIDE HEALTH NETWORK (Active)
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Main Details
Name
ADVOCATE NORTH SIDE HEALTH NETWORK
Subdivision Name
IMC MOC PET - Nuclear Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140182X
Medicare Provider Number
140182
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2025
Participating Start Date
4/1/2025
Participating Approval Date
1/29/2025
Last Recertification Date
Contacts
Authorizing Official
Advocate Aurora Health Care
Nan Nelson, SVP-Finance
(414) 378-4765
Primary Contact
Advocate Aurora Health
Jason G Nowak, Director, Pharmacy 340B Program
(414) 640-8457
Addresses
Street Address
3000 N Halsted Street
Suite 100
Chicago, IL 60657
Billing Address
ADVOCATE NORTH SIDE HEALTH NETWORK
836 WEST WELLINGTON AVE
CHICAGO, IL 60657
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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