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PRESENCE SAINT JOSEPH HOSPITAL-CHICAGO
DSH140180 Presence Saints Mary and Elizabeth Medical Center
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Covered Entity Details
Entity Name
Presence Saints Mary and Elizabeth Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140180
Entity Address
2233 WEST DIVISION STREET
CHICAGO, IL 60622
Medicare Provider Number
140180
Participating Start Date
7/1/2003
Last Recertification Date
8/16/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
PRESENCE SAINT JOSEPH HOSPITAL-CHICAGO
Pharmacy Address
PHARMACY
2900 N LAKE SHORE DR
CHICAGO, IL 60657-5640
Pharmacy Comments
Contract Details
Approval Date
10/24/2012
Contract Begin Date
10/24/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Suzanne Lambert, VP, Patient Care Services
(312) 770-2107
Contract Pharmacy Representative
Roberta Luskin-Hawk, Executive Vice President
(773) 665-3972
Signed By Date
9/21/2012
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