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DSH140114L SWEDISH COVENANT HEALTH (Active)
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Main Details
Name
SWEDISH COVENANT HEALTH
Subdivision Name
SWEDISH HOSPITAL INFUSION CENTER NI - Infusion Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140114L
Medicare Provider Number
140114
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2021
Participating Start Date
7/1/2021
Participating Approval Date
4/22/2021
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Swedish Covenant Health
Jonathan Lind, Chief Operating Officer
(773) 907-1028
Primary Contact
Swedish Covenant Health
Alicia Juska, Director Pharmacy
(773) 878-8200 Ext: 5379
Addresses
Street Address
6450 W TOUHY AVE
STE 210
NILES, IL 60714-4512
Billing Address
Swedish Covenant Health
5145 N California Ave
Chicago, IL 60625
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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