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CH05662D ALIVIO MEDICAL CENTER, INC (Active)
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Main Details
Name
ALIVIO MEDICAL CENTER, INC
Subdivision Name
ALIVIO MEDICAL CENTER
Type
HRSA-Funded Health Center
Site ID
BPS-H80-001154
340B ID
CH05662D
Grant Number
H80CS00116
Additional Details
Current Program Status
Active
Registration Date
1/1/1998
Participating Start Date
1/1/1998
Participating Approval Date
7/20/2005
Last Recertification Date
2/26/2025
Contacts
Authorizing Official
Alivio Medical Center
ESTHER CORPUZ, CHIEF EXECUTIVE OFFICER
(312) 829-6304
Primary Contact
Alivio Medical Center
Ankit Prakash Patel, CFO
(312) 312-2719
Addresses
Street Address
966 W 21st St
Chicago, IL 60608-4511
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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7/20/05 - CHANGED 340B ID # DUE TO ADMINISTRATIVE CHANGE
12/22/2006
April 2025
April 2025
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