340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
UNIV OF ILLINOIS WOOD STREET
DSH140150 UNIVERSITY OF ILLINOIS HOSPITAL
Print
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
UNIV OF ILLINOIS WOOD STREET
Pharmacy Address
PCC PHARMA
840 S WOOD ST RM 163
M/C 884
CHICAGO, IL 60612-4325
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Avijit Ghosh, Interim Vice President and CFO
(217) 265-0263
Contract Pharmacy Representative
University of Illinois Wood St. Pharmacy
Cedomir Micic, Assistant Director
(312) 413-1583
Signed By Date
1/15/2015
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session