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DSH140150 UNIVERSITY OF ILLINOIS HOSPITAL (Active)
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Main Details
Name
UNIVERSITY OF ILLINOIS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140150
Medicare Provider Number
140150
Additional Details
Current Program Status
Active
Registration Date
2/19/2008
Participating Start Date
7/1/2009
Participating Approval Date
6/9/2009
Last Recertification Date
8/31/2024
Contacts
Authorizing Official
University of Illinois Hospital
Laurence Appel, Chief Financial Officer
(312) 996-3620
Primary Contact
University of Illinois Hospital
Christina Maria Carrizales Cortez, Assistant Director, 340B Compliance
(312) 996-3692
Addresses
Street Address
1740 W Taylor St.
CHICAGO, IL 60612
Billing Address
University of Illinois
Invoice Processing Center
PO Box 820
Rantoul, IL 61866
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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5/7/10 REMOVED MEDICAID# (WAS 376000511001); 7/1/09 REINSTATED ORIG PART FROM 4/1/2001 TO 3/30/2008, DID NOT TO PART FROM 4/1/2008 TO 6/30/2009
05/07/2010
April 2025
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