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DSH140276V LOYOLA UNIVERSITY MEDICAL CENTER (Active)
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Main Details
Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
LOYOLA UNIVERSITY MEDICAL CENTER, RENAL DIALYSIS
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140276V
Medicare Provider Number
140276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
3/9/2010
Participating Start Date
4/1/2010
Participating Approval Date
3/15/2010
Last Recertification Date
9/2/2024
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
OUTPATIENT/MAIN HOSPITAL NEPHROLOGY; LUH - 3306
2160 South First Avenue
MAYWOOD, IL 60153
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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3/3/2010- DOC. RECD. TO CONFIRM DSH ADJ. %.
03/09/2010
April 2025
April 2025
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