340B Drug Pricing Program Database
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DSH140304D ADVENTIST BOLINGBROOK HOSPITAL (Terminated)
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Main Details
Name
ADVENTIST BOLINGBROOK HOSPITAL
Subdivision Name
PT Solutions at Adventist Bolingbrook Hospital
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140304D
Medicare Provider Number
140304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/7/2013
Participating Start Date
1/1/2014
Participating Approval Date
12/6/2013
Last Recertification Date
9/3/2019
Termination Date
Termination Reason
10/1/2019
Business decision by the Covered Entity
Contacts
Authorizing Official
AdventHealth GlenOaks
Vladimir Radivojevic, President & CEO
(630) 545-7258
Primary Contact
Tallgrass Corporate Center
Kim Whiteleather, Pharmacy Data Analyst 340B
(630) 914-2438
Addresses
Street Address
396 Remington Blvd
Suite 100
Bolingbrook, IL 60440
Billing Address
Adventist Bolingbrook Hospital
c/o Ascension Ministry Service Center
PO Box 33902
Indianapolis, IN 46203
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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