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I.G.G. of AMERICA, Inc. d/b/a US Bioservices
DSH140018 MOUNT SINAI HOSPITAL MEDICAL CENTER
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Covered Entity Details
Entity Name
MOUNT SINAI HOSPITAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140018
Entity Address
2750 W 15TH PLACE
CHICAGO, IL 60608-1797
Medicare Provider Number
140018
Participating Start Date
10/1/2004
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
I.G.G. of AMERICA, Inc. d/b/a US Bioservices
Pharmacy Address
514 PROGRESS DRIVE
SUITE X
LINTHICUM, MD 21090
Pharmacy Comments
Contract Details
Approval Date
6/11/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michele Mazurek, Hospital Chief Administator
(773) 257-5021
Contract Pharmacy Representative
US Bioservices Corporation
Mischelle Smoot, Pharmacist in Charge
(888) 518-7246
Signed By Date
6/11/2020
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