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UNIVERSITY OF CHICAGO MEDICAL CENTER
DSH140304 UChicago Medicine AdventHealth Bolingbrook
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Covered Entity Details
Entity Name
UChicago Medicine AdventHealth Bolingbrook
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140304
Entity Address
500 REMINGTON BLVD.
BOLINGBROOK, IL 60440-4988
Medicare Provider Number
140304
Participating Start Date
10/1/2009
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
UNIVERSITY OF CHICAGO MEDICAL CENTER
Pharmacy Address
DBA UCMC PHARMACY SERVICES
1551 HUNTINGTON DR STE B
CALUMET CITY, IL 60409
Pharmacy Comments
Contract Details
Approval Date
4/12/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jared Brown, Chief Financial Officer
(630) 312-6003
Contract Pharmacy Representative
U of Chicago Medicine
Gregory Kovak, Pharmacy manager
(773) 834-2285
Signed By Date
4/12/2023
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