Contract Pharmacy Details

AMERICAN DRUGS STORES LLC
DSH140276 LOYOLA UNIVERSITY MEDICAL CENTER

Covered Entity Details

Entity Name

LOYOLA UNIVERSITY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140276

Entity Address

2160 SOUTH FIRST AVENUE
MAYWOOD, IL 60153

Medicare Provider Number

140276

Participating Start Date

4/1/2010

Last Recertification Date

9/9/2024

Pharmacy Details

Pharmacy Name

AMERICAN DRUGS STORES LLC

Pharmacy Address

DBA OSCO DRUG #3053
12803 S HARLEM AVE
PALOS HEIGHTS, IL 60463

Pharmacy Comments

Contract Details

Approval Date

4/8/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/20/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Daniel Post, Executive Vice President
(708) 216-1670

Contract Pharmacy Representative

Safeway
charles Hanson, 340B program manager
(208) 395-6304

Signed By Date

4/8/2019

340B Drug Pricing Program Database