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ST. ALEXIUS MEDICAL CENTER
DSH140290 ST. ALEXIUS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. ALEXIUS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140290
Entity Address
1555 BARRINGTON ROAD
HOFFMAN ESTATES, IL 60169
Medicare Provider Number
140290
Participating Start Date
7/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
ST. ALEXIUS MEDICAL CENTER
Pharmacy Address
DBA ST. ALEXIUS MED CTR OUTPATIENT PHARM
1555 BARRINGTON RD STE 115
HOFFMAN ESTATES, IL 60169-1062
Pharmacy Comments
Contract Details
Approval Date
7/1/2020
Contract Begin Date
7/28/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sun C Lee-Such, VP Pharmacy
(224) 273-2390
Contract Pharmacy Representative
AMITA Health
Myra Priser, Pharmacy Manager
(630) 856-8126
Signed By Date
7/1/2020
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