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OGDEN PHARMACY, INC.
DSH140029 COPLEY MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
COPLEY MEMORIAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140029
Entity Address
2000 OGDEN AVENUE
AURORA, IL 60504
Medicare Provider Number
140029
Participating Start Date
4/1/2008
Last Recertification Date
8/29/2024
Pharmacy Details
Pharmacy Name
OGDEN PHARMACY, INC.
Pharmacy Address
OGDEN PHARMACY
2040 OGDEN AVE STE 117
AURORA, IL 60504
Pharmacy Comments
Contract Details
Approval Date
7/13/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brenda VanWyhe, SENIOR VP FINANCE AND CFO
(630) 898-3565
Contract Pharmacy Representative
Ogden Pharmacy
Mohammed Alahmed, Pharmacist
(347) 218-3636
Signed By Date
7/13/2023
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