340B Drug Pricing Program Database
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DSH140304H UChicago Medicine AdventHealth Bolingbrook (Active)
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Main Details
Name
UChicago Medicine AdventHealth Bolingbrook
Subdivision Name
UChicago Medicine AdventHealth Medication Therapy Management Clinic Bolingbrook
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140304H
Medicare Provider Number
140304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/13/2023
Participating Start Date
10/1/2023
Participating Approval Date
7/25/2023
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
UChicago Medicine AdventHealth Bolingbrook
Tristan R Shaw, CFO
(630) 312-6008
Primary Contact
UChicago Medicine AdventHealth Bolingbrook
DAVID TSANG, 340B PROGRAM DIRECTOR
(847) 372-8408
Addresses
Street Address
500 REMINGTON BLVD
BOLINGBROOK, IL 60440-4906
Billing Address
UChicago Medicine AdventHealth Bolingbrook
c/o AdventHealth
902 Inspiration Avenue
Suite 9100
Altamonte Springs, FL 32714
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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