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DSH140150U UNIVERSITY OF ILLINOIS HOSPITAL (Active)
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Main Details
Name
UNIVERSITY OF ILLINOIS HOSPITAL
Subdivision Name
UIH - Telemedicine IDOC
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140150U
Medicare Provider Number
140150
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/15/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/20/2015
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
University of Illinois Hospital
Laurence Appel, Chief Financial Officer
(312) 996-3620
Primary Contact
University of Illinois Hospital
Christina Maria Carrizales Cortez, Assistant Director, 340B Compliance
(312) 996-3692
Addresses
Street Address
1940 W. Taylor St., 3rd Floor
Chicago, IL 60612
Billing Address
University of Illinois
Invoice Processing Center
PO Box 820
Rantoul, IL 61866
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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