340B Drug Pricing Program Database
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RRC140281-19 NORTHWESTERN MEMORIAL HOSPITAL (Terminated)
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Main Details
Name
NORTHWESTERN MEMORIAL HOSPITAL
Subdivision Name
NORTHWESTERN MEMORIAL HOSPITAL - Lavin Family Pavilion CT Scan
Type
Rural Referral Center
Rural
Yes
340B ID
RRC140281-19
Medicare Provider Number
140281
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/15/2020
Participating Start Date
8/7/2020
Participating Approval Date
7/31/2020
Last Recertification Date
9/11/2020
Termination Date
Termination Reason
10/1/2020
Never implemented the 340B Program
Contacts
Authorizing Official
Northwestern Memorial Hospital
Francis Donald Fraher, CFO
(312) 926-5236
Primary Contact
Northwestern Memorial Hospital
Richard Jacobson, Director of Pharmacy
(312) 926-3024
Addresses
Street Address
259 E ERIE ST
CHICAGO, IL 60611-2987
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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