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DSH140182A ADVOCATE NORTH SIDE HEALTH NETWORK (Active)
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Main Details
Name
ADVOCATE NORTH SIDE HEALTH NETWORK
Subdivision Name
ADVOCATE ILLINOIS MASONIC CRETICOS / Creticos Cancer Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140182A
Medicare Provider Number
140182
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/15/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/4/2015
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Advocate Aurora Health Care
Nan Nelson, SVP-Finance
(414) 378-4765
Primary Contact
Advocate Aurora Health
Jason G Nowak, Director, Pharmacy 340B Program
(414) 640-8457
Addresses
Street Address
900 W. NELSON AVE
CHICAGO, IL 60657-6708
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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