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HEALTH DELIVERY MANAGEMENT, L.L.C.
DSH140029 COPLEY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
COPLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140029
Entity Address
2000 OGDEN AVENUE
AURORA, IL 60504
Medicare Provider Number
140029
Participating Start Date
4/1/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
HEALTH DELIVERY MANAGEMENT, L.L.C.
Pharmacy Address
DBA RUSH CANCER CENTER PHARMACY
1520 W HARRISON ST RM 09115
CHICAGO, IL 60607
Pharmacy Comments
Contract Details
Approval Date
10/7/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brenda VanWyhe, SENIOR VP FINANCE AND CFO
(630) 898-3565
Contract Pharmacy Representative
Health Delivery Management, L.L.C.
Matthew Kemper, Director, Clinical Operations
(312) 563-2326
Signed By Date
10/7/2020
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