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ADVENTIST MIDWEST HEALTH
DSH140217 PRESENCE SAINT JOSEPH HOSPITAL ELGIN
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Covered Entity Details
Entity Name
PRESENCE SAINT JOSEPH HOSPITAL ELGIN
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140217
Entity Address
77 NORTH AIRLITE ST.
ELGIN, IL 60123
Medicare Provider Number
140217
Participating Start Date
4/1/2021
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
ADVENTIST MIDWEST HEALTH
Pharmacy Address
DBA UCHICAGO MEDICINE ADVENTHEALTH PHARM
120 N OAK ST
HINSDALE, IL 60521
Pharmacy Comments
Contract Details
Approval Date
4/5/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/29/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Larkin, Chief Financial Officer
(630) 801-2729
Contract Pharmacy Representative
AMITA Health
Myra Priser, Pharmacy Manager
(630) 856-8126
Signed By Date
4/5/2021
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