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AMIJAY CORPORATION
DSH140133 HOLY CROSS HOSPITAL
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Covered Entity Details
Entity Name
HOLY CROSS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140133
Entity Address
2701 WEST 68TH STREET
CHICAGO, IL 60629
Medicare Provider Number
140133
Participating Start Date
7/1/2005
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
AMIJAY CORPORATION
Pharmacy Address
3441 W NORTH AVE
DBA LAPUJA PHARMACY
CHICAGO, IL 60647-4841
Pharmacy Comments
Contract Details
Approval Date
1/13/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele Mazurek, Hospital Chief Administator
(773) 257-5021
Contract Pharmacy Representative
Lapuja Pharmacy
Mukesh Patel, Pharmacy Owner
(847) 927-1933
Signed By Date
1/13/2020
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