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ASCENSION RX 1001
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
ASCENSION RX 1001
Pharmacy Address
ASCENSION PHARMACY SERVICES, LLC.
7701 METROPOLIS DR STE 200B
AUSTIN, TX 78744-3125
Pharmacy Comments
Contract Details
Approval Date
7/3/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/31/2025
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kevin Larkin, CFO
(847) 888-3696
Contract Pharmacy Representative
Ascension Rx
Angela Pascuzzi, Pharmacist In Charge
(833) 633-7279
Signed By Date
7/3/2024
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