Contract Pharmacy Details

PRESENCE CHICAGO HOSPITALS NETWORK
DSH140174 PRESENCE MERCY MEDICAL CENTER

Covered Entity Details

Entity Name

PRESENCE MERCY MEDICAL CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140174

Entity Address

1325 NORTH HIGHLAND AVENUE, ATTN: ADMINISTRATION
AURORA, IL 60506

Medicare Provider Number

140174

Participating Start Date

4/1/2010

Last Recertification Date

8/16/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

PRESENCE CHICAGO HOSPITALS NETWORK

Pharmacy Address

DBA AMITA HEALTH HOME INFUSION PHARMACY
7435 W TALCOTT AVE STE T1289
CHICAGO, IL 60631

Pharmacy Comments

Contract Details

Approval Date

1/3/2022

Contract Begin Date

4/1/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kevin Larkin, Chief Financial Officer
(630) 801-2729

Contract Pharmacy Representative

Amita Health
Laura Ozelie, Pharmacy Director, Home Infusion
(219) 765-4450

Signed By Date

1/3/2022

340B Drug Pricing Program Database