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DSH140054D MACNEAL HOSPITAL (Active)
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Main Details
Name
MACNEAL HOSPITAL
Subdivision Name
Family Practice -PC-MacNeal
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140054D
Medicare Provider Number
140054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/26/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/5/2018
Last Recertification Date
9/9/2024
Contacts
Authorizing Official
Loyola Medicine
Melissa M. Lukasick, CFO Illinois Region
(708) 216-5723
Primary Contact
Loyola Medicine
Zohra Saleem, Regional 340B Manager
(708) 216-3875
Addresses
Street Address
3231 EUCLID AVE 5TH FLR
BERWYN, IL 60402-4603
Billing Address
MacNeal Hospital
3249 SOUTH OAK PARK AVENUE
BERWYN, IL 60402
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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Participated starting 10/1/2018; terminated 10/1/2018; Reinstated 1/1/2019.
11/01/2018
May 2025
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