Contract Pharmacy Details

AMERICAN DRUG STORES LLC
DSH140208 ADVOCATE CHRIST MEDICAL CENTER

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

AMERICAN DRUG STORES LLC

Pharmacy Address

DBA OSCO DRUG 3192
17930 WOLF RD
ORLAND PARK, IL 60467

Pharmacy Comments

Contract Details

Approval Date

7/13/2017

Contract Begin Date

10/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/9/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

ROBERT PEKOFSKE, VP FINANCE
(708) 684-5133

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

7/13/2017

340B Drug Pricing Program Database