340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
DSH140054C MACNEAL HOSPITAL (Terminated)
Print
Main Details
Name
MACNEAL HOSPITAL
Subdivision Name
BERWYN MAGNETIC RESONANCE CENTER - MRI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140054C
Medicare Provider Number
140054
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/26/2018
Participating Start Date
1/1/2019
Participating Approval Date
11/5/2018
Last Recertification Date
9/11/2020
Termination Date
Termination Reason
7/1/2021
Hospital Outpatient facility no longer eligible
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
3345 OAK PARK AVE
BERWYN, IL 60402-3434
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Comment
Last Updated On
1
Item
1
to
1
of
1
Page:
of 1
Go
Page size:
Change
Participated starting 10/1/2018; terminated 10/1/2018; Reinstated 1/1/2019.
11/01/2018
May 2025
May 2025
week
S
M
T
W
T
F
S
18
27
28
29
30
1
2
3
19
4
5
6
7
8
9
10
20
11
12
13
14
15
16
17
21
18
19
20
21
22
23
24
22
25
26
27
28
29
30
31
23
1
2
3
4
5
6
7
NoFilter
Contains
DoesNotContain
StartsWith
EndsWith
EqualTo
NotEqualTo
GreaterThan
LessThan
GreaterThanOrEqualTo
LessThanOrEqualTo
Between
NotBetween
IsEmpty
NotIsEmpty
IsNull
NotIsNull
Custom
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session