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THE ATRIUM PHARMACY
DSH140223 ADVOCATE LUTHERAN GENERAL HOSPITAL
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Covered Entity Details
Entity Name
ADVOCATE LUTHERAN GENERAL HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140223
Entity Address
1775 W. DEMPSTER STREET
PARK RIDGE, IL 60068
Medicare Provider Number
140223
Participating Start Date
10/1/2016
Last Recertification Date
Entity Termination Date
7/1/2017
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
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2017
Contacts
Covered Entity Signing Official
Lizabeth Hickey, Interim VP Finance
(847) 723-2220
Contract Pharmacy Representative
Nikki Himmell, Pharmacist
(309) 268-5797
Signed By Date
10/13/2016
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