340B Drug Pricing Program Database
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RRC140223-05 ADVOCATE LUTHERAN GENERAL HOSPITAL (Active)
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Main Details
Name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Subdivision Name
Occupational Therapy - O/P Wound Care
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140223-05
Medicare Provider Number
140223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/3/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/5/2019
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
8816 Dempster Ave
Niles, IL 60714
Billing Address
Advocate Lutheran General Hospital
1775 W. Dempster Street
Park Ridge, IL 60068
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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