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ADVENTIST MIDWEST HEALTH
DSH140180 Presence Saints Mary and Elizabeth Medical Center
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Covered Entity Details
Entity Name
Presence Saints Mary and Elizabeth Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140180
Entity Address
2233 WEST DIVISION STREET
CHICAGO, IL 60622
Medicare Provider Number
140180
Participating Start Date
7/1/2003
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
ADVENTIST MIDWEST HEALTH
Pharmacy Address
DBA UCHICAGO MEDICINE ADVENTHEALTH HINSD
120 N OAK ST
HINSDALE, IL 60521
Pharmacy Comments
Contract Details
Approval Date
10/1/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/29/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Mike James Mulay, CFO
(312) 770-2105
Contract Pharmacy Representative
AMITA Health
Myra Priser, Pharmacy Manager
(630) 856-8126
Signed By Date
10/1/2018
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