340B Drug Pricing Program Database
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DSH140206E Humboldt Park Health (Active)
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Main Details
Name
Humboldt Park Health
Subdivision Name
OP Oncology/ Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140206E
Medicare Provider Number
140206
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/8/2013
Participating Start Date
4/1/2013
Participating Approval Date
1/10/2013
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Humboldt Park Health
Kenneth Coe, 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. Mozart Ave
Suite 206
Chicago, IL 60622
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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