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DSH140304A UChicago Medicine AdventHealth Bolingbrook (Active)
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Main Details
Name
UChicago Medicine AdventHealth Bolingbrook
Subdivision Name
UChicago Medicine AdventHealth Pain Management Bolingbrook
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140304A
Medicare Provider Number
140304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/7/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/6/2013
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
UChicago Medicine AdventHealth Bolingbrook
Tristan R Shaw, CFO
(630) 312-6008
Primary Contact
UChicago Medicine AdventHealth Bolingbrook
DAVID TSANG, 340B PROGRAM DIRECTOR
(847) 372-8408
Addresses
Street Address
420 South Schmidt Road
Suite 135
Bolingbrook, IL 60440-1754
Billing Address
UChicago Medicine AdventHealth Bolingbrook
c/o AdventHealth
902 Inspiration Avenue
Suite 9100
Altamonte Springs, FL 32714
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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