340B Drug Pricing Program Database
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DSH140182V ADVOCATE NORTH SIDE HEALTH NETWORK (Terminated)
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Main Details
Name
ADVOCATE NORTH SIDE HEALTH NETWORK
Subdivision Name
Electroencephalography - Neurology EEG
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140182V
Medicare Provider Number
140182
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/6/2021
Participating Start Date
1/1/2022
Participating Approval Date
10/7/2021
Last Recertification Date
9/2/2022
Termination Date
Termination Reason
10/1/2023
Business decision by the Covered Entity
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
3000 N Halsted Street
100 & 220
Chicago, IL 60657
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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