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UNIVERSITY OF ILLINOIS
DSH140150 UNIVERSITY OF ILLINOIS HOSPITAL
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Covered Entity Details
Entity Name
UNIVERSITY OF ILLINOIS HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140150
Entity Address
1740 W Taylor St.
CHICAGO, IL 60612
Medicare Provider Number
140150
Participating Start Date
7/1/2009
Last Recertification Date
8/31/2024
Pharmacy Details
Pharmacy Name
UNIVERSITY OF ILLINOIS
Pharmacy Address
OUTPATIENT CARE CENTER PHARMACY
1801 W TAYLOR ST STE 3B MC 884
CHICAGO, IL 60612
Pharmacy Comments
Contract Details
Approval Date
4/12/2013
Contract Begin Date
7/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
WILLIAM DEVONEY, CFO
(312) 996-3620
Contract Pharmacy Representative
Christina Godwin, Pharmacy Supervisor
(312) 413-0045
Signed By Date
4/12/2013
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