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PROVIDENT HOSPITAL OF COOK COUNTY
DSH140124AD JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY
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Covered Entity Details
Entity Name
JOHN H. STROGER, JR. HOSPITAL OF COOK COUNTY
Subdivision Name
Professional Building - Urology - Urology
Type
Disproportionate Share Hospital
340B ID
DSH140124AD
Entity Address
1950 West Polk Street
Chicago, IL 60612
Medicare Provider Number
140124
Outpatient Facility Provider Number
Participating Start Date
1/1/2023
Last Recertification Date
8/15/2024
Pharmacy Details
Pharmacy Name
PROVIDENT HOSPITAL OF COOK COUNTY
Pharmacy Address
ATTENTION PHARMACY DEPARTMENT
500 E 51ST ST
ROOM 2050
CHICAGO, IL 60615-2400
Pharmacy Comments
Contract Details
Approval Date
10/11/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pamela Cassara, Chief Financial Officer
(312) 864-5507
Contract Pharmacy Representative
Cook County Health & Hospitals System
CaTanya Norwood, Senior Director of Pharmacy
(312) 864-2213
Signed By Date
10/11/2023
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