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DSH140088M THE UNIVERSITY OF CHICAGO MEDICAL CENTER (Terminated)
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Main Details
Name
THE UNIVERSITY OF CHICAGO MEDICAL CENTER
Subdivision Name
University of Chicago Medicine - Infusion Therapy
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140088M
Medicare Provider Number
140088
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/10/2017
Participating Start Date
1/1/2018
Participating Approval Date
10/24/2017
Last Recertification Date
Termination Date
Termination Reason
1/1/2018
Other
Contacts
Authorizing Official
University of Chicago Medicine
Richard Walter Silveria, EVP and CFO
(773) 834-2802
Primary Contact
The University of Chicago Medical Center
Brent E. Fiedler, Director, Pharmacy Contracting, Finance and Metrics
(773) 702-2289
Addresses
Street Address
14290 S LaGrange Road
Suite 2202
Orland Park, IL 60462-2023
Billing Address
The University of Chicago Medical Center
8201 S. Cass Ave.
Darien, IL 60561
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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