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PROFESSIONAL OFFICE BUILDING
DSH140119 RUSH UNIVERSITY MEDICAL CENTER
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Covered Entity Details
Entity Name
RUSH UNIVERSITY MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140119
Entity Address
1653 W CONGRESS PKWY
CHICAGO, IL 60612
Medicare Provider Number
140119
Participating Start Date
12/1/2005
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
PROFESSIONAL OFFICE BUILDING
Pharmacy Address
PHARMACY
1725 W HARRISON ST STE 418
CHICAGO, IL 60612-3849
Pharmacy Comments
6/28/2013 - Per OPA request, DEA number and pharmacy information corrected (was listed as Klein Alvin Charles, Becker Prof Pharmacy Inc., 4744 North Western Avenue, Chicago, IL 60625 to Professional Office Building Pharmacy in error).
Contract Details
Approval Date
10/4/2012
Contract Begin Date
10/4/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John Mordach, Chief Financial Officer
(312) 942-5600
Contract Pharmacy Representative
Rush University Medical Center
Scott Sonnenschein, Vice President Hospital Operations
(312) 563-2093
Signed By Date
9/11/2012
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