340B Drug Pricing Program Database
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AFFILIATED HEALTH SERVICES, INC.
DSH140224 PRESENCE SAINT JOSEPH HOSP-CHICAGO
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Covered Entity Details
Entity Name
PRESENCE SAINT JOSEPH HOSP-CHICAGO
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140224
Entity Address
2900 NORTH LAKE SHORE DRIVE
CHICAGO, IL 60657
Medicare Provider Number
140224
Participating Start Date
7/1/2021
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
AFFILIATED HEALTH SERVICES, INC.
Pharmacy Address
DBA ASCENSION RX 1303
30055 NORTHWESTERN HWY
STE 225
FARMINGTON HILLS, MI 48334
Pharmacy Comments
Contract Details
Approval Date
4/6/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/26/2022
Ownership change
Contacts
Covered Entity Signing Official
Flavio Marin, CFO
(847) 316-4190
Contract Pharmacy Representative
Ascension Michigan Pharmacy
Deborah Sopo, Pharmacy Manager
(248) 865-3770
Signed By Date
4/6/2021
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