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DSH140276Z LOYOLA UNIVERSITY MEDICAL CENTER (Active)
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Main Details
Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
LOYOLA CANCER CARE & RESEARCH AT THE MARJORIE G. WEINBERG CANCER CENTER AT MELROSE PARK
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140276Z
Medicare Provider Number
140276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
5/20/2011
Participating Start Date
7/1/2011
Participating Approval Date
6/15/2011
Last Recertification Date
9/8/2024
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
715 WEST NORTH AVENUE
MELROSE PARK, IL 60160
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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