340B Drug Pricing Program Database
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DSH140182K ADVOCATE NORTH SIDE HEALTH NETWORK (Active)
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Main Details
Name
ADVOCATE NORTH SIDE HEALTH NETWORK
Subdivision Name
ADVOCATE ILLINOIS MASONIC - MRI
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140182K
Medicare Provider Number
140182
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/1/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/10/2019
Last Recertification Date
8/14/2024
Contacts
Authorizing Official
Advocate Aurora Health Care
Nan Nelson, SVP-Finance
(414) 378-4765
Primary Contact
Advocate Aurora Health
Jason G Nowak, Director, Pharmacy 340B Program
(414) 640-8457
Addresses
Street Address
3000 N Halsted Street Suite 100
Chicago
Chicago, IL 60657
Billing Address
Advocate Northside Health System
836 West Wellington Ave.
Chicago, IL 60657
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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