340B Drug Pricing Program Database
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DSH140208A ADVOCATE CHRIST MEDICAL CENTER (Terminated)
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Main Details
Name
ADVOCATE CHRIST MEDICAL CENTER
Subdivision Name
Physical Therapy - Peds Rehab Outpatient Pavillion
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140208A
Medicare Provider Number
140208
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/3/2019
Participating Start Date
1/1/2020
Participating Approval Date
11/8/2019
Last Recertification Date
9/2/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
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
12350 S. Harlem
Palos Heights, IL 60463
Billing Address
Advocate Christ Medical Center
4440 W 95th Street
Oak Lawn, IL 60453
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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