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PREMIER SPECIALTY INFUSION LLC
DSH140114 SWEDISH COVENANT HEALTH
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Covered Entity Details
Entity Name
SWEDISH COVENANT HEALTH
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140114
Entity Address
5145 N CALIFORNIA
CHICAGO, IL 60625
Medicare Provider Number
140114
Participating Start Date
7/1/2004
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
PREMIER SPECIALTY INFUSION LLC
Pharmacy Address
2401 HASSEL RD. SUITE # 1525
HOFFMAN ESTATES, IL 60169-6016
Pharmacy Comments
Contract Details
Approval Date
10/16/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/3/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Patricia King, Vice President Legal Affairs
(773) 989-8811
Contract Pharmacy Representative
Premier Specialty Infusion LLC
Scott Luckow, Pharmacy manager
(800) 783-9655
Signed By Date
10/16/2017
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