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Trinity Health Pharmacy Services, LLC
DSH140054 MACNEAL HOSPITAL
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Covered Entity Details
Entity Name
MACNEAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140054
Entity Address
3249 SOUTH OAK PARK AVENUE
BERWYN, IL 60402
Medicare Provider Number
140054
Participating Start Date
1/1/2019
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
Trinity Health Pharmacy Services, LLC
Pharmacy Address
12279 Bluffton Road
Fort Waye, IN 46809
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Daniel Post, Executive Vice President
(708) 216-1670
Contract Pharmacy Representative
TRINITY HEALTH
ZACHARY ROBERTS, DIRECTOR OF SPECIALTY PHARMACY
(734) 343-7606
Signed By Date
10/14/2019
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