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ADVENTIST MIDWEST HEALTH
DSH140292 UChicago Medicine AdventHealth GlenOaks
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Covered Entity Details
Entity Name
UChicago Medicine AdventHealth GlenOaks
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140292
Entity Address
701 WINTHROP AVENUE
GLENDALE HEIGHTS, IL 60139-1405
Medicare Provider Number
140292
Participating Start Date
7/1/2005
Last Recertification Date
9/4/2024
Pharmacy Details
Pharmacy Name
ADVENTIST MIDWEST HEALTH
Pharmacy Address
DBA UCHICAGO MEDICINE ADVENTHEALTH PHARM
120 N OAK ST
HINSDALE, IL 60521
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/13/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
CHASE AALBORG, CFO
(630) 312-6001
Contract Pharmacy Representative
AMITA Health
Myra Priser, Pharmacy Manager
(630) 856-8126
Signed By Date
4/12/2018
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