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ALEXIAN BROTHERS MEDICAL CENTER
DSH140290 ST. ALEXIUS MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. ALEXIUS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140290
Entity Address
1555 BARRINGTON ROAD
HOFFMAN ESTATES, IL 60169
Medicare Provider Number
140290
Participating Start Date
7/1/2017
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
ALEXIAN BROTHERS MEDICAL CENTER
Pharmacy Address
OUTPATIENT PHARMACY
800 BIESTERFIELD RD
ELK GROVE VILLAGE, IL 60007
Pharmacy Comments
Contract Details
Approval Date
4/5/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/3/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Larkin, CFO
(847) 888-3696
Contract Pharmacy Representative
Ascension
Andrius Cepenas, System Director Ambulatory Care and Retail Pharmacy Services
(773) 368-5340
Signed By Date
4/5/2023
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