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WAL-MART PHARMACY 10-2956
DSH140208 ADVOCATE CHRIST MEDICAL CENTER
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Covered Entity Details
Entity Name
ADVOCATE CHRIST MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140208
Entity Address
4440 W 95TH ST
OAK LAWN, IL 60453
Medicare Provider Number
140208
Participating Start Date
7/1/2011
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-2956
Pharmacy Address
1401 IL ROUTE 59
SHOREWOOD, IL 60431
Pharmacy Comments
Contract Details
Approval Date
10/15/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2016
Agreement registered in error
Contacts
Covered Entity Signing Official
ROBERT PEKOFSKE, VP FINANCE
(708) 684-5133
Contract Pharmacy Representative
WALMART
Julie Howard, Manager Contracting & Channel Management
(479) 277-1498
Signed By Date
10/15/2015
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