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PRESENCE CHICAGO HOSPITALS NETWORK
DSH140290 ST. ALEXIUS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. ALEXIUS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140290
Entity Address
1555 BARRINGTON ROAD
HOFFMAN ESTATES, IL 60169
Medicare Provider Number
140290
Participating Start Date
7/1/2017
Last Recertification Date
8/13/2024
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
1/31/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Sun C Lee-Such, VP Pharmacy
(224) 273-2390
Contract Pharmacy Representative
Amita Health
Laura Ozelie, Pharmacy Director, Home Infusion
(219) 765-4450
Signed By Date
1/3/2022
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