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ASCENSION RX 1001
DSH140292 UChicago Medicine AdventHealth GlenOaks
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Covered Entity Details
Entity Name
UChicago Medicine AdventHealth GlenOaks
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140292
Entity Address
701 WINTHROP AVENUE
GLENDALE HEIGHTS, IL 60139-1405
Medicare Provider Number
140292
Participating Start Date
7/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
ASCENSION RX 1001
Pharmacy Address
ASCENSION PHARMACY SERVICES, LLC.
7701 METROPOLIS DR STE 200B
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
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
10/12/2021
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