340B Drug Pricing Program Database
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DSH140304B ADVENTIST BOLINGBROOK HOSPITAL (Terminated)
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Main Details
Name
ADVENTIST BOLINGBROOK HOSPITAL
Subdivision Name
Outpatient Women's Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140304B
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
8/20/2020
Termination Date
Termination Reason
7/1/2021
Business decision by the Covered Entity
Contacts
Authorizing Official
AdventHealth GlenOaks
Vladimir Radivojevic, President & CEO
(630) 545-7258
Primary Contact
Amita Health
Rick Fischer, System Director, 340B
(630) 309-7828
Addresses
Street Address
396 Remington Blvd
Suite 235/231
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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May 2025
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