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DSH140048 ADVOCATE SOUTHLAND HEALTH NETWORK (Active)
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Main Details
Name
ADVOCATE SOUTHLAND HEALTH NETWORK
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140048
Medicare Provider Number
140048
Additional Details
Current Program Status
Active
Registration Date
7/8/2015
Participating Start Date
10/1/2015
Participating Approval Date
8/25/2015
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
2320 E. 93RD ST.
CHICAGO, IL 60617
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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8/25/15 previously participating from 4/1/2006 thru 9/30/2013; not participating from 10/1/2013 thru 9/30/2015 due to request of entity, reinstated effective 10/1/2015 based on on-line registration submitted in July 2015
08/25/2015
5/26/15 previously participating from 4/1/2006 thru 9/30/2013; not participating from 10/1/2013 thru 6/30/2015 due to request of entity, reinstated effective 7/1/2015 based on on-line registration submitted in April 2015
05/26/2015
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