340B Drug Pricing Program Database
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RRC140223-16 ADVOCATE LUTHERAN GENERAL HOSPITAL (Active)
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Main Details
Name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Subdivision Name
CT Scan - CAC PET
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140223-16
Medicare Provider Number
140223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/10/2025
Participating Start Date
4/1/2025
Participating Approval Date
2/12/2025
Last Recertification Date
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 1370
Park Ridge, IL 60068
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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Participating from effective date: (07/01/2020) until terminated effective date: (04/01/2024); reinstatement effective date: (04/1/2025)
02/07/2025
May 2025
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