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DSH140223 ADVOCATE LUTHERAN GENERAL HOSPITAL (Terminated)
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Main Details
Name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140223
Medicare Provider Number
140223
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/12/2016
Last Recertification Date
Termination Date
Termination Reason
7/1/2017
DSH percentage below statutory minimum
Contacts
Authorizing Official
Lizabeth Hickey, Interim VP Finance
(847) 723-2220
Primary Contact
Debby Bryniarski, DIR PHARMACY
(847) 723-5879
Addresses
Street Address
1775 W. DEMPSTER STREET
PARK RIDGE, IL 60068
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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