Yes
| Contract Detail | M AND D PHARMACY, LLC | DBA: MORELAND AND DEVITT PHARMACY |
201 S STATE ST
| BEARDSTOWN | IL | 62618 | 07/26/2018 | 10/01/2018 | | | 10/01/2018 |
| Contract Detail | M&D VIRGINIA | MORELAND AND DEVITT, INC. |
118 E. BEARDSTOWN ST.
| VIRGINIA | IL | 62691 | 07/26/2018 | 10/01/2018 | | | 10/01/2018 |
| Contract Detail | MORELAND AND DEVITT INC | 124 N CONGRESS ST |
P.O. BOX 319
| RUSHVILLE | IL | 62681 | 07/26/2018 | 10/01/2018 | | | 10/01/2018 |
| Contract Detail | MORELAND AND DEVITT, INC. | 200 N. PITTSFIELD RD. |
STE B
| MT STERLING | IL | 62353 | 07/26/2018 | 10/01/2018 | | | 10/01/2018 |
| CAH141333-01 | Child | CAH | Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital | SCHUYLER COUNTY HOSPITAL DISTRICT - Elmer Hugh Taylor Clinic | 100W 15TH ST | BEARDSTOWN | IL | Active |
| CAH141333-02 | Child | CAH | Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital | Schuyler County Hospital District Community Medical Clinic Astoria - Rural Health Clinic | 135 W Broadway | Astoria | IL | Active |
| CAH141333-03 | Child | CAH | Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital | RUSHVILLE FAMILY PRACTICE - Rural Health Clinic | 233 S CONGRESS ST | RUSHVILLE | IL | Active |
| CAH141333-04 | Child | CAH | Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital | Community Medical Clinic of Table Grove - Rural Health Clinic | 130 N Broadway Street | Table Grove | IL | Terminated |
| Details | Last Recertification Date | Update | Recertification | 9/6/2023 10:43:49 AM | 8/26/2024 11:24:59 AM | 8/26/2024 11:24 AM |
| Details | Last Recertification Date | Update | Recertification | 8/29/2022 3:17:34 PM | 9/6/2023 10:43:49 AM | 9/6/2023 10:43 AM |
| Details | Last Recertification Date | Update | Recertification | 8/31/2021 3:44:58 PM | 8/29/2022 3:17:34 PM | 8/29/2022 3:17 PM |
| Details | Last Recertification Date | Update | Recertification | 9/2/2020 12:02:00 PM | 8/31/2021 3:44:58 PM | 8/31/2021 3:44 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 9/2/2020 12:02 PM |
| Medicaid Billing | Medicaid: Number | Insert | Recertification | | 371354458003 | 9/2/2020 12:02 PM |
| Medicaid Billing | Medicaid: State | Insert | Recertification | | IL | 9/2/2020 12:02 PM |
| Medicaid Billing | NPI: Number | Insert | Recertification | | 1871546465 | 9/2/2020 12:02 PM |
| Medicaid Billing | NPI: State | Insert | Recertification | | IL | 9/2/2020 12:02 PM |
| Details | Last Recertification Date | Update | Recertification | 8/26/2019 1:08:13 PM | 9/2/2020 12:02:00 PM | 9/2/2020 12:02 PM |
| Details | Last Recertification Date | Update | Recertification | | 8/26/2019 1:08:13 PM | 8/26/2019 1:08 PM |
| Details | State | Update | | Approved | Active | 10/1/2018 12:05 AM |
| Contacts | Signed By | Insert | New Registration | | Gadberry, Tamra S
Chief Financial Officer
Schuyler County Hospital District
2173225296 | 7/26/2018 10:15 AM |
| Details | 340B ID | Update | New Registration | | CAH141333-02 | 7/26/2018 10:15 AM |
| Details | Entity Subname | Update | New Registration | Schuyler County Hospital District Community Medical Clinic Astoria | Schuyler County Hospital District Community Medical Clinic Astoria - Rural Health Clinic | 7/26/2018 10:15 AM |
| Dates | Participating Approval Date | Update | New Registration | | 7/26/2018 10:15:54 AM | 7/26/2018 10:15 AM |
| Details | State | Update | New Registration | Pending | Approved | 7/26/2018 10:15 AM |
| Dates | Signed By Date | Update | New Registration | | 7/17/2018 6:07:54 PM | 7/26/2018 10:15 AM |
| Dates | Start Date | Update | New Registration | | 10/1/2018 12:00:00 AM | 7/26/2018 10:15 AM |
| Addresses | Main Address | Insert | New Registration | |
135 W Broadway
Astoria, IL 61501 | 7/17/2018 6:07 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Gadberry, Tamra S
Chief Financial Officer
Schuyler County Hospital District
2173225296 | 7/17/2018 6:07 PM |
| Contacts | Primary Contact | Insert | New Registration | | Brockhouse, Sarah
Pharmacist
Schuyler County Hospital District
2173224321-5294 | 7/17/2018 6:07 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Details | Grant Number | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Details | 340B ID | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Details | Medicare Provider Number | Insert | New Registration | | 141333 | 7/17/2018 6:07 PM |
| Details | Entity Name | Insert | New Registration | | Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital | 7/17/2018 6:07 PM |
| Details | Program Code | Insert | New Registration | | CAH | 7/17/2018 6:07 PM |
| Details | Entity Subname | Insert | New Registration | | Schuyler County Hospital District Community Medical Clinic Astoria | 7/17/2018 6:07 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Details | State | Insert | New Registration | | Pending | 7/17/2018 6:07 PM |
| Dates | Registration Date | Insert | New Registration | | 7/17/2018 6:07:52 PM | 7/17/2018 6:07 PM |
| Dates | Signed By Date | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Dates | Start Date | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Terminations | Termination Date | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 7/17/2018 6:07 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 7/17/2018 6:07 PM |