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PHARMASCRIPT INC.
DSH140068 ROSELAND COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
ROSELAND COMMUNITY HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140068
Entity Address
45 WEST 111TH STREET
CHICAGO, IL 60628
Medicare Provider Number
140068
Participating Start Date
10/1/2014
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
PHARMASCRIPT INC.
Pharmacy Address
5437 N. BROADWAY AVENUE
CHICAGO, IL 60640-1703
Pharmacy Comments
Contract Details
Approval Date
1/11/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tim Egan, President
(773) 995-3015
Contract Pharmacy Representative
Pharmascript Inc
Jim L Alexander, CFO
(773) 275-8390
Signed By Date
1/11/2024
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