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DSH140276CR LOYOLA UNIVERSITY MEDICAL CENTER (Active)
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Main Details
Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
Loyola Outpatient Center - Rad Oncology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140276CR
Medicare Provider Number
140276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/31/2019
Last Recertification Date
9/8/2024
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
2160 S. First Avenue
Maywood, IL 60153
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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