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DSH140114B SWEDISH COVENANT HEALTH (Active)
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Main Details
Name
SWEDISH COVENANT HEALTH
Subdivision Name
WOUND CARE CLINIC
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140114B
Medicare Provider Number
140114
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2008
Participating Start Date
10/14/2008
Participating Approval Date
10/14/2008
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Swedish Covenant Health
Jonathan Lind, Chief Operating Officer
(773) 907-1028
Primary Contact
Swedish Covenant Health
Alicia Juska, Director Pharmacy
(773) 878-8200 Ext: 5379
Addresses
Street Address
2751 W. WINNONA AVENUE, AP3 FLOOR
CHICAGO, IL 60625
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/23/12 remove medicaid number
02/23/2012
April 2025
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