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SWEDISH COVENANT HEALTH
DSH140114D SWEDISH COVENANT HEALTH
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Covered Entity Details
Entity Name
SWEDISH COVENANT HEALTH
Subdivision Name
OPERATING ROOM / ONE DAY SURGICAL PATIENTS
Type
Disproportionate Share Hospital
340B ID
DSH140114D
Entity Address
5140 N. CALIFORNIA AVENUE, SUITE #G200
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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