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ASCENSION RX 3001
DSH140304 UChicago Medicine AdventHealth Bolingbrook
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Covered Entity Details
Entity Name
UChicago Medicine AdventHealth Bolingbrook
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140304
Entity Address
500 REMINGTON BLVD.
BOLINGBROOK, IL 60440-4988
Medicare Provider Number
140304
Participating Start Date
10/1/2009
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
ASCENSION RX 3001
Pharmacy Address
7701 METROPOLIS DR STE 200C
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
7/19/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/31/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vladimir Radivojevic, President & CEO
(630) 545-7258
Contract Pharmacy Representative
Ascension Pharmacy Services, LLC
Lynn Eschenbacher, Chief Pharmacy Officer
(314) 884-0593
Signed By Date
7/19/2021
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