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DSH140114J Swedish Covenant Hospital (Terminated)
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Main Details
Name
Swedish Covenant Hospital
Subdivision Name
Outpatient Oncology Infusion Center Evanston
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140114J
Medicare Provider Number
140114
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/8/2014
Participating Start Date
7/1/2014
Participating Approval Date
6/11/2014
Last Recertification Date
8/19/2016
Termination Date
Termination Reason
4/1/2017
Site closure
Contacts
Authorizing Official
Swedish Covenant Hospital
Patricia King, Vice President Legal Affairs
(773) 989-8811
Primary Contact
Swedish Covenant Hospital
Ramesh Patel, Director Pharmacy
(773) 878-8200 Ext: 5379
Addresses
Street Address
800 Austin Ave.
Suite 607
Evanston, IL 60202
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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