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DSH140276EM LOYOLA UNIVERSITY MEDICAL CENTER (Terminated)
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Main Details
Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
Loyola Center for Health at Elmwood Park - Got Ctr For Health - Loyola Center for Health at Elmwood Park - Got Ctr For Health
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH140276EM
Medicare Provider Number
140276
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/1/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/25/2020
Last Recertification Date
8/29/2022
Termination Date
Termination Reason
10/1/2023
Site closure
Contacts
Authorizing Official
Loyola Medicine
Melissa M. Lukasick, CFO Illinois Region
(708) 216-5723
Primary Contact
Loyola Medicine
Zohra Saleem, Regional 340B Manager
(708) 216-3875
Addresses
Street Address
7255 W. Grand Avenue
Elmwood Park, IL 60707
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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