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DSH140276AG LOYOLA UNIVERSITY MEDICAL CENTER (Terminated)
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Main Details
Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
Loyola Center for Health at Chicago
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140276AG
Medicare Provider Number
140276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/16/2017
Participating Start Date
4/1/2017
Participating Approval Date
2/22/2017
Last Recertification Date
9/11/2020
Termination Date
Termination Reason
7/1/2021
Site closure
Contacts
Authorizing Official
Loyola University Medical Center
Daniel Paul Isacksen, EVP and Regional CFO
(708) 216-4252
Primary Contact
Loyola Medicine
Joe Vadakara, Regional Pharmacy Director
(708) 216-0399
Addresses
Street Address
7634 W. Belmont Ave
Chicago, IL 60634
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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