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ACCREDO HEALTH GROUP, INC.
DSH140276A LOYOLA UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
LOYOLA UNIVERSITY MEDICAL CENTER
Subdivision Name
LOYOLA UNIVERSITY MEDICAL CENTER - CARDINAL BERNARDIN CANCER CENTER
Type
Disproportionate Share Hospital
340B ID
DSH140276A
Entity Address
2160 SOUTH FIRST AVENUE
MAYWOOD, IL 60153-3304
Medicare Provider Number
140276
Outpatient Facility Provider Number
Participating Start Date
4/1/2010
Last Recertification Date
9/8/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
1/17/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/30/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Daniel Paul Isacksen, EVP and Regional CFO
(708) 216-4252
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
1/17/2022
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