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DSH140206 Humboldt Park Health (Active)
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Main Details
Name
Humboldt Park Health
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140206
Medicare Provider Number
140206
Additional Details
Current Program Status
Active
Registration Date
4/23/2008
Participating Start Date
7/1/2004
Participating Approval Date
4/23/2008
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Humboldt Park Health
Thomas Garvey, Chief Financial Officer
(773) 292-8200 Ext: 8208
Primary Contact
Humboldt Park Health
Ravina Gandhakwala, Director of Pharmacy
(773) 292-8200 Ext: 7380
Addresses
Street Address
1044 N FRANCISCO AVENUE
CHICAGO, IL 60622
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/17/11 REVISED MEDICAID # (WAS 363394548001)
08/17/2011
April 2025
April 2025
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