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DSH140181 SOUTH SHORE HOSPITAL CORPORATION (Active)
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Main Details
Name
SOUTH SHORE HOSPITAL CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140181
Medicare Provider Number
140181
Additional Details
Current Program Status
Active
Registration Date
1/11/2022
Participating Start Date
4/1/2022
Participating Approval Date
2/25/2022
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
South Shore Hospital
Leslie M. Rogers, CEO
(773) 356-5200
Primary Contact
South Shore Hospital
Yi Yang, Director of Pharmacy
(773) 356-5237
Addresses
Street Address
8012 SOUTH CRANDON AVENUE
CHICAGO, IL 60617-1175
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 4/1/2018, terminated 4/1/2018. Reinstated 4/1/2022.
02/24/2022
Participating from effective date (10/1/2016) until terminated effective date (1/1/2018, reinstated effective date (04/01/2018)
01/11/2018
8/12/16 Participated starting 7/1/2008, terminated 10/1/2013, reinstated effective 10/1/2016
08/12/2016
May 2025
May 2025
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