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J AND M PHARMACY INC
DSH140181 SOUTH SHORE HOSPITAL CORPORATION
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Covered Entity Details
Entity Name
SOUTH SHORE HOSPITAL CORPORATION
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140181
Entity Address
8012 SOUTH CRANDON AVENUE
CHICAGO, IL 60617-1175
Medicare Provider Number
140181
Participating Start Date
4/1/2022
Last Recertification Date
8/21/2024
Pharmacy Details
Pharmacy Name
J AND M PHARMACY INC
Pharmacy Address
LOCAL HEALTH PHARMACY - HARVEY
31 W 155TH ST
SUITE 1000
HARVEY, IL 60426
Pharmacy Comments
Contract Details
Approval Date
7/5/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/23/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Timothy A. Caveney, President/CEO
(773) 356-5200
Contract Pharmacy Representative
OneroRx dba Local Health Pharmacy
Michael Wolnerman, RPh, CCIM
(515) 829-0406
Signed By Date
7/5/2022
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