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SWEDISH COVENANT HEALTH
DSH140114B SWEDISH COVENANT HEALTH
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Covered Entity Details
Entity Name
SWEDISH COVENANT HEALTH
Subdivision Name
WOUND CARE CLINIC
Type
Disproportionate Share Hospital
340B ID
DSH140114B
Entity Address
2751 W. WINNONA AVENUE, AP3 FLOOR
CHICAGO, IL 60625
Medicare Provider Number
140114
Outpatient Facility Provider Number
Participating Start Date
10/14/2008
Last Recertification Date
8/13/2024
Pharmacy Details
Pharmacy Name
SWEDISH COVENANT HEALTH
Pharmacy Address
DBA GALTER MEDICAL PAVILION PHARMACY
5140 N CALIFORNIA AVE # G105
CHICAGO, IL 60625
Pharmacy Comments
Contract Details
Approval Date
11/4/2008
Contract Begin Date
11/4/2008
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2023
Ownership change
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
10/29/2008
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