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INGALLS HEALTH VENTURES
DSH140088 THE UNIVERSITY OF CHICAGO MEDICAL CENTER
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Covered Entity Details
Entity Name
THE UNIVERSITY OF CHICAGO MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140088
Entity Address
5841 S. MARYLAND AVE.
CHICAGO, IL 60637
Medicare Provider Number
140088
Participating Start Date
10/1/2003
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
INGALLS HEALTH VENTURES
Pharmacy Address
1551 HUNTINGTON DR STE A
CALUMET CITY, IL 60409
Pharmacy Comments
Contract Details
Approval Date
11/23/2021
Contract Begin Date
11/23/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/30/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Phillip L. Kaufman, Vice President – Finance Shared Services
(773) 702-9665
Contract Pharmacy Representative
U of Chicago Medicine
Sandeep Parsad, Pharmacy Director
(773) 702-3584
Signed By Date
11/23/2021
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