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ADVOCATE HOME CARE PRODUCTS
DSH140182 ADVOCATE NORTH SIDE HEALTH NETWORK
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Covered Entity Details
Entity Name
ADVOCATE NORTH SIDE HEALTH NETWORK
Subdivision Name
DBA ADVOCATE ILLINOIS MASONIC MEDICAL CENTER (AIMMC)
Type
Disproportionate Share Hospital
340B ID
DSH140182
Entity Address
836 West Wellington Ave.
CHICAGO, IL 60657
Medicare Provider Number
140182
Participating Start Date
10/27/2005
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
ADVOCATE HOME CARE PRODUCTS
Pharmacy Address
1441 BRANDING AVE STE 310
DOWNERS GROVE, IL 60515-5624
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
JACK GILBERT, VP FINANCE
(773) 296-7809
Contract Pharmacy Representative
Paul Miller, Pharmacy Manager
(630) 829-4535
Signed By Date
7/13/2016
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