340B Drug Pricing Program Database
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DSH140250 SOUTH SUBURBAN HOSPITAL (Terminated)
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Main Details
Name
SOUTH SUBURBAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140250
Medicare Provider Number
140250
Additional Details
Current Program Status
Terminated
Registration Date
7/8/2016
Participating Start Date
10/1/2016
Participating Approval Date
7/13/2016
Last Recertification Date
11/9/2017
Termination Date
Termination Reason
7/1/2018
DSH percentage below statutory minimum
Contacts
Authorizing Official
Advocate Trinity Hospital
Brian Kelly, VP Finance, Advocate Trinity Hospital
(708) 213-3004
Primary Contact
Advocate Healthcare
Zohra Saleem, 340B Manager
(630) 929-5626
Addresses
Street Address
17800 Kedzie Ave
HAZELCREST, IL 60429
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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