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ADVENTIST MIDWEST HEALTH
DSH140304 UChicago Medicine AdventHealth Bolingbrook
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Covered Entity Details
Entity Name
UChicago Medicine AdventHealth Bolingbrook
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140304
Entity Address
500 REMINGTON BLVD.
BOLINGBROOK, IL 60440-4988
Medicare Provider Number
140304
Participating Start Date
10/1/2009
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ADVENTIST MIDWEST HEALTH
Pharmacy Address
D/B/A ADVENTIST HINSDALE HOSPITAL
1 SALT CREEK LN RM 1414
HINSDALE, IL 60521-2936
Pharmacy Comments
Contract Details
Approval Date
4/2/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/23/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vladimir Radivojevic, President & CEO
(630) 545-7258
Contract Pharmacy Representative
Amita Health
Debra Sproat, Pharmacy Manager
(630) 286-5500
Signed By Date
4/2/2020
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