340B Drug Pricing Program Database
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RRC140223-15 ADVOCATE LUTHERAN GENERAL HOSPITAL (Active)
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Main Details
Name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Subdivision Name
Magnetic Resonance Imaging - MRI
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140223-15
Medicare Provider Number
140223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/9/2020
Participating Start Date
7/1/2020
Participating Approval Date
4/13/2020
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
1700 Luther Lane
Suite 1350
Park Ridge, IL 60068
Billing Address
Advocate Lutheran General Hospital
1775 W. Dempster Street
Park Ridge, IL 60068
Comments
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