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DSH140083 LORETTO HOSPITAL (Active)
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Main Details
Name
LORETTO HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140083
Medicare Provider Number
140083
Additional Details
Current Program Status
Active
Registration Date
12/6/2005
Participating Start Date
12/6/2005
Participating Approval Date
12/6/2005
Last Recertification Date
8/29/2024
Contacts
Authorizing Official
Loretto Hospital
Kenneth McGhee, CFO
(773) 854-5008
Primary Contact
Loretto Hospital
Niraj Gandhi, Director of Pharmacy
(773) 854-5540
Addresses
Street Address
645 SOUTH CENTRAL
CHICAGO, IL 60644
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/24/2010- DOC. RECD. TO CONFIRM ELIG. OWNERSHIP TYPE
03/24/2010
April 2025
April 2025
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