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RARE SPECIALTY PHARMACY
DSH140158 Insight Hospital and Medical Center Chicago
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Covered Entity Details
Entity Name
Insight Hospital and Medical Center Chicago
Subdivision Name
MAIN SITE
Type
Disproportionate Share Hospital
340B ID
DSH140158
Entity Address
2525 S. MICHIGAN AVENUE
CHICAGO, IL 60616
Medicare Provider Number
140158
Participating Start Date
7/1/2004
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
RARE SPECIALTY PHARMACY
Pharmacy Address
398 W GRAND AVE
RAHWAY, NJ 07065
Pharmacy Comments
Contract Details
Approval Date
1/16/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Baseer Tajuddin, General Counsel
(217) 377-6978
Contract Pharmacy Representative
Rare Specailty Pharmacy
Fabian Herrera, Owner
(973) 262-2628
Signed By Date
1/16/2025
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