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DSH140276FA LOYOLA UNIVERSITY MEDICAL CENTER (Approved)
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Main Details
Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
Tinley Urgent Care Center - Tinley Urgent Care Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140276FA
Medicare Provider Number
140276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Approved
Registration Date
4/1/2025
Participating Start Date
7/1/2025
Participating Approval Date
4/7/2025
Last Recertification Date
Contacts
Authorizing Official
Loyola Medicine
Melissa M. Lukasick, CFO Illinois Region
(708) 216-5723
Primary Contact
Loyola Medicine
Zohra Saleem, Regional 340B Manager
(708) 216-3875
Addresses
Street Address
17901 S LA GRANGE ROAD
Tinley Park, IL 60487
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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