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DSH140276AU LOYOLA UNIVERSITY MEDICAL CENTER (Terminated)
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Main Details
Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
Homer Glen - Subspecialty
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140276AU
Medicare Provider Number
140276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2019
Participating Start Date
4/1/2019
Participating Approval Date
1/31/2019
Last Recertification Date
9/7/2023
Termination Date
Termination Reason
1/1/2024
Other
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
15750 Marian Drive
Homer Glen, IL 60491
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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