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PRESENCE CHICAGO HOSPITALS NETWORK
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
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
1/7/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/23/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Vladimir Radivojevic, President & CEO
(630) 545-7258
Contract Pharmacy Representative
Amita Health
Laura Ozelie, Pharmacy Director, Home Infusion
(219) 765-4450
Signed By Date
1/7/2022
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