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THE ATRIUM PHARMACY
DSH140127 ADVOCATE BROMENN MEDICAL CENTER
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Covered Entity Details
Entity Name
ADVOCATE BROMENN MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140127
Entity Address
1304 FRANKLIN AVENUE
NORMAL, IL 61761
Medicare Provider Number
140127
Participating Start Date
1/1/2019
Last Recertification Date
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
THE ATRIUM PHARMACY
Pharmacy Address
ADVOCATE HEALTH & HOSPITALS CORPORATION
1304 FRANKLIN AVENUE
LEVEL 1
NORMAL, IL 61761
Pharmacy Comments
Contract Details
Approval Date
7/13/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
Contacts
Covered Entity Signing Official
Aron Klein, VP Finance
(309) 268-2410
Contract Pharmacy Representative
Advocate BroMenn Hospital
Steve Pinneke, Director of Pharmacy
(309) 268-5199
Signed By Date
7/13/2016
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