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DSH140150AE UNIVERSITY OF ILLINOIS HOSPITAL (Active)
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Main Details
Name
UNIVERSITY OF ILLINOIS HOSPITAL
Subdivision Name
UIH - HEART CENTER AT ROOSEVELT
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140150AE
Medicare Provider Number
140150
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/13/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/22/2017
Last Recertification Date
8/30/2024
Contacts
Authorizing Official
University of Illinois Hospital
Laurence Appel, Chief Financial Officer
(312) 996-3620
Primary Contact
University of Illinois Hospital
Christina Maria Carrizales Cortez, Assistant Director, 340B Compliance
(312) 996-3692
Addresses
Street Address
1640 W ROOSEVELT RD
RM 336
CHICAGO, IL 60608-1316
Billing Address
University of Illinois
Invoice Processing Center
PO Box 820
Rantoul, IL 61866
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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