Covered Entity Details

CH05332F SIHF Healthcare (Terminated) - information as of 5/4/2025 10:25:25 PM

Main Details

Name

SIHF Healthcare

Subdivision Name

ALTON HEALTH CENTER

Type

HRSA-Funded Health Center

Site ID

BPS-H80-005636

340B ID

CH05332F

Grant Number

H80CS00195

Additional Details

Current Program Status

Terminated

Registration Date

7/1/2001

Participating Start Date

7/1/2001

Participating Approval Date

9/30/2004

Last Recertification Date

2/9/2018

Termination Date
Termination Reason

4/1/2019
Site closure

Contacts

Authorizing Official

SIHF Healthcare
Larry McCulley, President
(618) 332-0694 Ext: 155

Primary Contact

SIHF Healthcare
Patrice M Howard, Senior Vice President
(618) 332-0694

Addresses

Street Address

550 LANDMARKS BLVD
ALTON, IL 62002-6321

Billing Address

SIHF Healthcare
2041 Goose Lake Road
Sauget, IL 62206

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
4/24/12 Changed contact from EDGAR BRANCH. NEW CONTACT INFOR	04/24/2012
NEW CONTACT INFOR	08/12/2005

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Same as Street Address

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	B & D PHARMACY	1 PROFESSIONAL DRIVE	SUITE 170	ALTON	IL	62002-5068	12/01/2005	12/01/2005		04/01/2019	04/01/2019

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	Address Cont.	City	State
CH053320	Active	BPS-H80-003510	SIHF Healthcare	SIHF Healthcare	2041 Goose Lake Rd,		Sauget	IL
CH05332A	Active	BPS-H80-004603	SIHF Healthcare	SIHF Healthcare - State Street	2001 State St		East Saint Louis	IL
CH05332AB	Terminated	BPS-H80-007554	SIHF Healthcare	SIHF Good Samaritan Health Center	815 E 5th St		Alton	IL
CH05332AC	Terminated	BPS-H80-010444	SIHF Healthcare	SIHF Healthcare - Children's Medical	2810 Frank Scott Pkwy W		Belleville	IL
CH05332AD	Terminated	BPS-H80-001735	SIHF Healthcare	Alton Women's Health Center	2 Memorial Dr	Suite 122	ALTON	IL
CH05332AE	Active	BPS-H80-021192	SIHF Healthcare	SIHF Healthcare - Belleville Family	180 South Third Street - Suite 104		Belleville	IL
CH05332AF	Terminated	BPS-H80-021261	SIHF Healthcare	Comprehensive Health Center	505 S 8TH ST		East Saint Louis	IL
CH05332AG	Active	BPS-H80-018452	SIHF Healthcare	SIHF Healthcare - Archview	2071 Goose Lake Rd		Sauget	IL
CH05332AH	Active	BPS-H80-020966	SIHF Healthcare	SIHF Healthcare - O'Fallon	3 St. Elizabeth’s Boulevard, Suite 4000		O Fallon	IL
CH05332AI	Active	BPS-H80-000818	SIHF Healthcare	SIHF Healthcare - West Belleville	7210 W Main St		Belleville	IL
CH05332AK	Active	BPS-H80-001962	SIHF Healthcare	SIHF Healthcare - Belleville Pediatrics	2900 Frank Scott Pkwy W - Suite 950		Belleville	IL
CH05332AL	Active	BPS-H80-005628	SIHF Healthcare	SIHF Healthcare - Windsor III	100 N. 8th St. - Suite 256		EAST ST LOUIS	IL
CH05332AM	Active	BPS-H80-005579	SIHF Healthcare	SIHF Healthcare - Fairmont City	2568 N 41ST ST		FAIRMONT	IL
CH05332AO	Terminated	BPS-H80-019256	SIHF Healthcare	Belleville Family Health Center	180 S 3rd St	Suite 103	Belleville	IL
CH05332AY	Terminated	BPS-H80-003364	SIHF Healthcare	CAHOKIA HEALTH CENTER	818 Upper Cahokia Rd		Cahokia	IL
CH05332BX	Terminated	BPS-H80-011932	Southern Illinois Health Care Foundation, Inc.	Central Collinsville Health Center	80 Burlington Street		Collinsville	IL
CH05332BY	Active	BPS-H80-008435	SIHF Healthcare	SIHF Healthcare - Bunker Hill	144 North Washington Street		Bunker Hill	IL
CH05332BZ	Active	BPS-H80-004018	SIHF Healthcare	SIHF Healthcare - Greenup	302 N Mill St		Greenup	IL
CH05332CA	Terminated	BPS-H80-008541	SIHF Healthcare	Belleville Family Health Center II	211 S 3rd St		Belleville	IL
CH05332CC	Active	BPS-H80-010194	SIHF Healthcare	SIHF Healthcare - Central Alton	2615 Edwards St - Suite 171		Alton	IL
CH05332CD	Active	BPS-H80-010920	SIHF Healthcare	SIHF Healthcare – Windsor II	100 N. 8th St. - Suite 120		East St Louis	IL
CH05332CF	Active	BPS-H80-032479	SIHF Healthcare	SIHF Healthcare - Mattoon	911 Remington Rd Ste B		Mattoon	IL
CH05332CG	Active	BPS-H80-011729	SIHF Healthcare	SIHF Healthcare - Olney	1120 N East St		Olney	IL
CH05332CH	Active	BPS-H80-012341	SIHF Healthcare	SIHF Healthcare - Millstadt	60 Regency Pl		Millstadt	IL
CH05332CJ	Active	BPS-H80-017600	SIHF Healthcare	SIHF Healthcare - Charleston	626 W. Lincoln Ave.		CHARLESTON	IL
CH05332CK	Terminated	BPS-H80-015066	SIHF Healthcare	Belleville Family Health Center	180 S 3rd St, Suite 300		Belleville	IL
CH05332CL	Active	BPS-H80-017024	SIHF Healthcare	SIHF Healthcare - Red Bud	824 Locust St		Red Bud	IL
CH05332CM	Terminated	BPS-H80-015067	SIHF Healthcare	Alton Women’s Health Center	2 MEMORIAL DR , SUITE 205		ALTON	IL
CH05332CN	Active	BPS-H80-018451	SIHF Healthcare	SIHF Healthcare - Illini Family	2900 Frank Scott Pkwy W - Suite 980		Belleville	IL
CH05332CP	Active	BPS-H80-018542	SIHF Healthcare	SIHF Healthcare - LifeLinks	750 Broadway Avenue East		Mattoon	IL
CH05332CQ	Terminated	BPS-H80-019335	SIHF Healthcare	Swansea Health Center	3214 North Illinois Street		Belleville	IL
CH05332CR	Active	BPS-H80-017932	SIHF Healthcare	SIHF Healthcare - Central Collinsville	1215 Vandalia St		Collinsville	IL
CH05332CS	Terminated	BPS-H80-019008	SIHF Healthcare	Arthur Health Center	525 N. Vine Street		Arthur	IL
CH05332CT	Active	BPS-H80-019256	SIHF Healthcare	SIHF Healthcare – Central Belleville	180 South Third Street - Suite 103		Belleville	IL
CH05332CU	Terminated	BPS-H80-002277	Southern Illinois Health Care Foundation, Inc.	BELLEVILLE FAMILY HEALTH	180 S 3rd St, Suite 201		Belleville	IL
CH05332CV	Active	BPS-H80-021786	SIHF Healthcare	SIHF Healthcare - Alton	4 Memorial Drive, Suite 210		Alton	IL
CH05332CW	Active	BPS-H80-021889	SIHF Healthcare	SIHF Healthcare - Windsor	100 N. 8th St.- Suite 232		East St Louis	IL
CH05332CX	Active	BPS-H80-027248	SIHF Healthcare	SIHF Healthcare - Arthur	1710 State Route 133		Arthur	IL
CH05332CY	Active	BPS-H80-032964	SIHF Healthcare	SIHF Healthcare - Collinsville School	9649 Collinsville Rd		Collinsville	IL
CH05332CZ	Active	BPS-H80-035372	SIHF Healthcare	SIHF Healthcare - Swansea	4969 Benchmark Centre Dr.		Swansea	IL
CH05332D	Terminated	BPS-H80-005601	Southern Illinois Health Care Foundation, Inc.	ADULT CARE CENTER	6010 Bond Ave		Centreville	IL
CH05332DA	Active	BPS-H80-034151	SIHF Healthcare	SIHF Healthcare - Danville School	202 E Fairchild St		Danville	IL
CH05332DB	Active	BPS-H80-032963	SIHF Healthcare	SIHF Healthcare Mobile Medical Unit	6000 BOND AVE		Centreville	IL
CH05332DC	Active	BPS-H80-036536	SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.	SIHF Healthcare – Alton Circle	2 Saint Anthonys Way STE 101		Alton	IL
CH05332DD	Active	BPS-H80-038090	SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.	SIHF Healthcare - Belleville Circle	180 S. 3rd St. STE 100		Belleville	IL
CH05332DE	Active	BPS-H80-038089	SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.	SIHF Healthcare - Multi-Specialty	180 S. 3rd St. STE 300		Belleville	IL
CH05332DF	Active	BPS-H80-038253	SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.	SIHF Healthcare – Glen Carbon	4230 IL-159		Glen Carbon	IL
CH05332DG	Active	BPS-H80-038263	SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.	SIHF Healthcare - Dupo School	600 Louisa Ave		Dupo	IL
CH05332DH	Active	BPS-H80-038753	SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC.	SIHF Healthcare – Belleville Circle II	311 W Lincoln St, Ste 200		Belleville	IL
CH05332F	Terminated	BPS-H80-005636	SIHF Healthcare	ALTON HEALTH CENTER	550 LANDMARKS BLVD		ALTON	IL
CH05332G	Active	BPS-H80-003118	SIHF Healthcare	SIHF Healthcare - Centreville	6000 BOND AVE		Centreville	IL
CH05332K	Active	BPS-H80-013963	SIHF Healthcare	SIHF Healthcare - East St. Louis School	4901 State St		East Saint Louis	IL
CH05332M	Active	BPS-H80-005594	SIHF Healthcare	SIHF Healthcare - Cahokia School	800 Range Ln		Cahokia	IL
CH05332N	Active	BPS-H80-000713	SIHF Healthcare	SIHF Healthcare - Bethalto	2 Terminal Drive - Suite 8		East Alton	IL
CH05332P	Active	BPS-H80-008137	SIHF Healthcare	SIHF Healthcare - Vandalia	1510 Sunset Dr		Vandalia	IL
CH05332R	Active	BPS-H80-001283	SIHF Healthcare	SIHF Healthcare - Salem	1275 Hawthorn Rd		Salem	IL
CH05332T	Active	BPS-H80-012186	SIHF Healthcare	SIHF Healthcare - Granite City	2166 Madison Ave		Granite City	IL
CH05332U	Terminated	BPS-H80-003717	Southern Illinois Health Care Foundation, Inc.	MADISON HEALTH CENTER	304 Madison Ave		Madison	IL
CH05332Z	Active	BPS-H80-009322	SIHF Healthcare	SIHF Healthcare - Effingham	900 W Temple Ave - Suite 208		Effingham	IL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH053320	5 GUYS RX II, LLC	DBA WELLCREEK PHARMACY-CHARLESTON	1 W LINCOLN AVE	CHARLESTON	IL	61920-3016	04/01/2022
CH053320	ACCREDO HEALTH GROUP INC	1620 CENTURY CENTER PKWY	# 109	MEMPHIS	TN	38134-8849	10/01/2020
CH053320	ACCREDO HEALTH GROUP INC	2040 W RIO SALADO PKWY STE 101B		TEMPE	AZ	85281-2010	10/01/2020
CH053320	ACCREDO HEALTH GROUP INC	3000 ERICSSON DRIVE, SUITE 100		WARRENDALE	PA	15086-7502	10/01/2020
CH053320	ACCREDO HEALTH GROUP, INC.	2825 W PERIMETER RD STE 112		INDIANAPOLIS	IN	46241	10/01/2020
CH053320	ACCREDO HEALTH GROUP, INC.	6272 LEE VISTA BLVD STE 100		ORLANDO	FL	32822	10/01/2020
CH053320	ACCREDO HEALTH GROUP, INC.	2 BOULDEN CIR STE 1		NEW CASTLE	DE	19720-3492	10/01/2020
CH053320	ADVANCED CARE SCRIPTS, INC	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	6251 CHANCELLOR DRIVE SUITE 101	ORLANDO	FL	32809	01/01/2020
CH05332N	B & D PHARMACY	1 PROFESSIONAL DRIVE	SUITE 170	ALTON	IL	62002-5068	12/01/2005
CH053320	B & D PHARMACY	1 PROFESSIONAL DRIVE	SUITE 170	ALTON	IL	62002-5068	07/01/2013	07/17/2017
CH05332F	B & D PHARMACY	1 PROFESSIONAL DRIVE	SUITE 170	ALTON	IL	62002-5068	12/01/2005	04/01/2019
CH05332AD	B & D PHARMACY	1 PROFESSIONAL DRIVE	SUITE 170	ALTON	IL	62002-5068	12/01/2005	04/01/2019
CH05332AB	B & D PHARMACY	1 PROFESSIONAL DRIVE	SUITE 170	ALTON	IL	62002-5068	09/04/2008	04/01/2019
CH053320	BANDY'S APOTHECARY SHOPS INC	BANDY'S PHARMACY II	207 E. HURON PO BOX 526	IRVINGTON	IL	62848	10/01/2024
CH053320	BANDY'S APOTHECARY SHOPS INC.	BANDY'S PHARMACY II	310 S. MAIN STREET PO BOX 308	WAYNE CITY	IL	62895	10/01/2024
CH053320	BANDY'S LTC LLC	DBA BANDY'S LONG TERM CARE PHARMACY	1415 W WHITTAKER ST	SALEM	IL	62881-2015	10/01/2021
CH053320	BANDY'S PHARMACY II	BANDY'S APOTHECARY SHOPS INC.	817 E MCCORD ST	CENTRALIA	IL	62801-3044	07/01/2020
CH053320	BANDY'S PHARMACY II	BANDY'S APOTHECARY SHOPS INC.	405 E. BROADWAY	TRENTON	IL	62293	10/01/2024
CH053320	BANDY'S PHARMACY INC	1413 W WHITTAKER ST	PO BOX 546	SALEM	IL	62881-2015	07/01/2013
CH05332R	BANDY'S PHARMACY INC	1413 W WHITTAKER ST	PO BOX 546	SALEM	IL	62881-2015	12/12/2005
CH053320	BOND COUNTY PHARMACY, LLC	224A E HARRIS AVE		GREENVILLE	IL	62246	10/01/2021
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05444	212 S LOGAN AVE	MATTOON	IL	61938	10/01/2016
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04024	5890 NORTH BELT WEST	BELLEVILLE	IL	62226	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02490	401 BELTLINE	COLLINSVILLE	IL	62234	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04337	172 E. MCARTHUR	BETHALTO	IL	62010	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02876	3001 BROADWAY ST	MOUNT VERNON	IL	62864	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04602	2510 STATE STREET	EAST ST LOUIS	IL	62205	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04971	2001 MADISON AVE.	GRANITE CITY	IL	62040	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02490	401 BELTLINE	COLLINSVILLE	IL	62234	07/01/2019	03/05/2021
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03627	1650 WASHINGTON AVE.	ALTON	IL	62002	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04599	704 CAMBRIDGE BLVD.	OFALLON	IL	62269	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04865	515 CARLYLE AVE.	BELLEVILLE	IL	62221	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04407	3732 NAMEOKI	GRANITE CITY	IL	62040	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03136	1201 CAMP JACKSON	CAHOKIA	IL	62206	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04832	6505 N. ILLINOIS	FAIRVIEW HEIGHTS	IL	62208	07/01/2019
CH053320	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03907	2532 N ILLINOIS ST	SWANSEA	IL	62226	07/01/2019
CH053320	CAIN'S DRUG STORE	1401 N 8TH ST		VANDALIA	IL	62471-1028	07/01/2013
CH05332P	CAIN'S DRUG STORE	1401 N 8TH ST		VANDALIA	IL	62471-1028	09/02/2008
CH053320	CAREMARK FLORIDA SPECIALTY PHARMACY LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7930 WOODLAND CENTER BLVD STE 500	TAMPA	FL	33614	01/01/2020
CH053320	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	01/01/2020
CH053320	CAREMARK KANSAS SPECIALTY PHARMACY	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	11162 RENNER BLVD	LENEXA	KS	66219	01/01/2020
CH053320	CAREMARK MASSACHUSETTS SPECIALTY PHARMAC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	25 BIRCH STREET, BLDG B, SUITE 100	MILFORD	MA	01757	01/01/2020
CH053320	CAREMARK MICHIGAN SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1307 ALLEN DR STE H	TROY	MI	48083	01/01/2020
CH053320	CAREMARK NEW JERSEY SPECIALTY PHCY, LLC	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	180 PASSAIC AVE UNIT B-5	FAIRFIELD	NJ	07004	01/01/2020
CH053320	CAREMARK NORTH CAROLINA SPECIALTY PHARMA	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	10700 WORLD TRADE BLVD STE 110	RALEIGH	NC	27617	01/01/2020
CH053320	CAREMARK TENNESSEE SPECIALTY PHARMACY, L	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	8370 WOLF LAKE DR STE 107	BARTLETT	TN	38133	01/01/2020
CH053320	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	1127 BRYN MAWR AVE SUITE A	REDLANDS	CA	92374	01/01/2020
CH053320	CAREMARK, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	7251 S. EASTERN AVE.	LAS VEGAS	NV	89119	10/01/2021
CH053320	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	01/01/2022
CH053320	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	01/01/2022
CH053320	CVS/SPECIALTY OR CARELONRX SPECIALTY PHA	CAREMARK, LLC	1001 SPINKS ROAD, STE 280	FLOWER MOUND	TX	75028	10/01/2021
CH053320	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2021
CH053320	ESI MAIL PHARMACY SERVICE	DBA EXPRESS SCRIPTS	7909 S HARDY DR STE 106	TEMPE	AZ	85284-1112	10/01/2020
CH053320	EXPRESS SCRIPTS	ESI MAIL PHARMACY SERVICE INC	4600 N HANLEY RD	SAINT LOUIS	MO	63134	10/01/2020
CH053320	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	4750 E. 450 S.	WHITESTOWN	IN	46075	10/01/2020
CH053320	EXPRESS SCRIPTS PHARMACY, INC.	DBA EXPRESS SCRIPTS	2040 ROUTE 130 NORTH	BURLINGTON	NJ	08016	10/01/2020
CH05332M	FISHER PHARMACY		B & D CORPORATION 2007 CAMP JACKSON ROAD	CAHOKIA	IL	62206	11/01/2004
CH05332G	FISHER PHARMACY		B & D CORPORATION 2007 CAMP JACKSON ROAD	CAHOKIA	IL	62206	11/01/2004
CH05332D	FISHER PHARMACY		B & D CORPORATION 2007 CAMP JACKSON ROAD	CAHOKIA	IL	62206	11/01/2004	04/01/2017
CH053320	FISHER PHARMACY		B & D CORPORATION 2007 CAMP JACKSON ROAD	CAHOKIA	IL	62206	11/01/2004	07/01/2016
CH05332AY	FISHER PHARMACY		B & D CORPORATION 2007 CAMP JACKSON ROAD	CAHOKIA	IL	62206	12/21/2005	04/01/2023
CH053320	GENOA HEALTHCARE LLC	12 NORTH 64TH STREET	SUITE 6	BELLEVILLE	IL	62223-3809	10/01/2024
CH053320	GENOA HEALTHCARE LLC	50 NORTHGATE INDUSTRIAL DR	ROOM 717	GRANITE CITY	IL	62040-6805	10/01/2024
CH053320	GENOA HEALTHCARE LLC	2615 EDWARDS ST STE 102		ALTON	IL	62002	10/01/2024
CH053320	GENOA HEALTHCARE LLC	2615 EDWARDS STREET, STE 102		ALTON	IL	62002-3915	10/01/2024
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02713	753 W HWY 50	O'FALLON	IL	62269	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06831	2701 GODFREY RD	GODFREY	IL	62035	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06371	914 W. MAIN ST.	OLNEY	IL	62450	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06921	225 N. POPLAR ST.	CENTRALIA	IL	62801	01/01/2020	09/06/2023
CH053320	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17396	5601 BELLEVILLE CROSSING ST	BELLEVILLE	IL	62226	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08638	501 W. LINCOLN AVE	CHARLESTON	IL	61920	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06693	207 W. JORDAN ST	NEWTON	IL	62448	01/01/2020	05/08/2023
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 03259	126 SOUTH BUCHANAN ST.	EDWARDSVILLE	IL	62025	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06832	2422 COLLEGE AVE.	ALTON	IL	62002	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06389	1022 W. MAIN ST.	SALEM	IL	62881	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02585	1803 N ILLINOIS ST.	SWANSEA	IL	62226	01/01/2020	11/08/2023
CH053320	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16869	3400 GREEN MOUNTCROSSING DR	SHILOH	IL	62269	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06926	12630 STATE ROUTE 143	HIGHLAND	IL	62249	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06830	4609 W. MAIN ST.	BELLEVILLE	IL	62226	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06833	1 WEST EDWARDSVILLE ROAD	WOOD RIVER	IL	62095	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	CVS/PHARMACY # 10951	3319 NAMEOKI RD.	GRANITE CITY	IL	62040	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17473	4701 N ILLINOIS ST	FAIRVIEW HEIGHTS	IL	62208	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #10774	506 EAST MAIN STREET	STAUNTON	IL	62088	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY # 2510	1800 VANDALIA ST.	COLLINSVILLE	IL	62234	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08661	1316 CHARLESTON AVE.	MATTOON	IL	61938	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06866	100 ADMIRAL TROST RD.	COLUMBIA	IL	62236	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06930	401 E. HARRIS	GREENVILLE	IL	62246	01/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06923	208 W. JACKSON ST.	SULLIVAN	IL	61951	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06385	1301 N. STATE ST.	FLORA	IL	62839	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06932	608 S. MAIN ST.	HILLSBORO	IL	62049	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06885	700 W. MAIN ST.	FAIRFIELD	IL	62837	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06694	808 S. MAIN STREET	PARIS	IL	61944	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06886	1101 W. MAIN ST.	CARMI	IL	62821	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06933	1205 E. GROVE AVE	RANTOUL	IL	61866	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06922	110 NORTH CEDAR ST.	SHELBYVILLE	IL	62565	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06887	915 N. MARKET ST.	MOUNT CARMEL	IL	62863	07/01/2020
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18038	907 E HIGHWAY 50	O FALLON	IL	62269	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18009	5720 N BELT W	BELLEVILLE	IL	62226	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18030	625 LINCOLN HWY	FAIRVIEW HEIGHTS	IL	62208	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY # 10759	303 SOUTH STATE STREET	JERSEYVILLE	IL	62052	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18014	2665 N ILLINOIS ST	SWANSEA	IL	62226	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18063	150 WATERLOO COMMONS DR	WATERLOO	IL	62298	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06386	1421 STATE ST.	LAWRENCEVILLE	IL	62439	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18069	3100 MADISON AVE.	GRANITE CITY	IL	62040	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06929	1171 FRANKLIN ST.	CARLYLE	IL	62231	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06390	2431 W. MAIN ST.	CARBONDALE	IL	62901	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06388	801 W. MAIN ST.	MARION	IL	62959	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06370	2700 BROADWAY	MOUNT VERNON	IL	62864	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04857	570 N. FAIRVIEW AVE.	DECATUR	IL	62522	01/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18066	2712 GODFREY RD	GODFREY	IL	62035	10/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18013	501 BELT LINE RD	COLLINSVILLE	IL	62234-4410	10/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18048	800 CARLYLE AVE	BELLEVILLE	IL	62221	10/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18033	1615 CAMP JACKSON RD	CAHOKIA	IL	62206	10/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18039	72 AIRPORT PLZ	BETHALTO	IL	62010	10/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18059	2222 TROY RD	EDWARDSVILLE	IL	62025	10/01/2021
CH053320	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY #18032	2811 HOMER M ADAMS PKWY	ALTON	IL	62002-4856	10/01/2021
CH053320	HOOK-SUPERX, L.L.C.	CVS/PHARMACY #11114	2800 ENTERPRISE ST STE 5	INDIANAPOLIS	IN	46219-1106	10/01/2021	05/15/2023
CH053320	KIRBY PHARMACY	KIRBY FOODS INC	101 S MERCHANT ST	EFFINGHAM	IL	62401-2425	07/01/2018
CH053320	LV HEALTH & WELLNESS PHARMACY	1219 THOUVENOT LANE	SUITE 111	SHILOH	IL	62269	07/01/2019
CH053320	MARTINS PHARMACY	101 S MERCHANT		EFFINGHAM	IL	62401	07/01/2013	07/01/2018
CH05332Z	MARTINS PHARMACY	101 S MERCHANT		EFFINGHAM	IL	62401	03/01/2009
CH05332BZ	MARTINS PHARMACY	101 S MERCHANT		EFFINGHAM	IL	62401	02/27/2012
CH053320	MARYVILLE PHARMACY	HEALTH MANAGEMENT ZONE, INC.	2700 N CENTER ST	MARYVILLE	IL	62062-5624	07/01/2013	10/14/2021
CH05332BX	MARYVILLE PHARMACY	HEALTH MANAGEMENT ZONE, INC.	2700 N CENTER ST	MARYVILLE	IL	62062-5624	06/21/2012	04/01/2017
CH053320	MARYVILLE PHARMACY	HEALTH MANAGEMENT ZONE, INC.	2700 N CENTER ST	MARYVILLE	IL	62062-5624	01/01/2021
CH053320	MEDEX PHARMACY INC	1704 NORTH ILLINOIS		SWANSEA	IL	62226-3948	07/01/2013	02/22/2019
CH053320	MEDICATE CENTRAL PHARMACY	1833 KINGSHIGHWAY	SUITE 100	WASHINGTON PARK	IL	62204-2135	07/01/2013
CH05332AI	MEDICATE CENTRAL PHARMACY	1833 KINGSHIGHWAY	SUITE 100	WASHINGTON PARK	IL	62204-2135	06/21/2012
CH05332AM	MEDICATE CENTRAL PHARMACY	1833 KINGSHIGHWAY	SUITE 100	WASHINGTON PARK	IL	62204-2135	03/24/2006
CH05332A	MEDICATE PHARMACY	100 N 8TH ST STE 100		EAST SAINT LOUIS	IL	62201-2989	03/24/2006
CH053320	MEDICATE PHARMACY	100 N 8TH ST STE 100		EAST SAINT LOUIS	IL	62201-2989	07/01/2013
CH053320	MEDICATE PHARMACY	2166 MADISON AVE		GRANITE CITY	IL	62040	10/01/2015
CH053320	MEDICATE PHARMACY	6000 BOND AVE		CENTREVILLE	IL	62207	10/01/2015
CH05332AL	MEDICATE PHARMACY	100 N 8TH ST STE 100		EAST SAINT LOUIS	IL	62201-2989	03/24/2006
CH05332T	MEDICATE PHARMACY	100 N 8TH ST STE 100		EAST SAINT LOUIS	IL	62201-2989	06/21/2012
CH05332T	MEDICATE PHARMACY	2166 MADISON AVE		GRANITE CITY	IL	62040	10/01/2015
CH05332U	MEDICATE PHARMACY	100 N 8TH ST STE 100		EAST SAINT LOUIS	IL	62201-2989	06/21/2012	04/01/2017
CH05332AO	MEDICINE EXPRESS	1704 NORTH ILLINOIS	SUITE 200	SWANSEA	IL	62226	06/21/2012	04/01/2023
CH05332CA	MEDICINE EXPRESS	1704 NORTH ILLINOIS	SUITE 200	SWANSEA	IL	62226	06/21/2012	10/01/2018
CH053320	MICHELLE'S PHARMACY INC.	809 S FRANKLIN ST		BUNKER HILL	IL	62014-1480	01/01/2018	10/25/2022
CH053320	MISSOURI CVS PHARMACY, L.L.C.	CVS/PHARMACY #18008	3431 UNION BLVD	SAINT LOUIS	MO	63115	01/01/2021
CH053320	MISSOURI CVS PHARMACY, L.L.C.	DBA CVS/PHARMACY # 2376	3925 LINDELL BLVD.	ST. LOUIS	MO	63108	10/01/2021
CH053320	OPTUM PHARMACY 701, LLC	4015 SHOPTON RD STE 600		CHARLOTTE	NC	28217-3025	10/01/2024
CH053320	OPTUM PHARMACY 701, LLC	1830 S HORNE		MESA	AZ	85204	10/01/2024
CH053320	OPTUMRX	OPTUMRX INC	6800 W 115TH ST STE 600	OVERLAND PARK	KS	66211-9838	10/01/2024
CH053320	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/01/2021
CH053320	PRINCIPIA HEALTH & WELLNESS PHARMACY INC	DBA SHIELDS FAMILY PHARMACY	1 PROFESSIONAL DR STE 170	ALTON	IL	62002-5069	01/25/2021	09/28/2023
CH053320	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	01/01/2020
CH053320	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY OR CARELONRX SPECIALTY	ONE WATERFRONT PLAZA 500 ALA MOANA BLVD., BLDG 1	HONOLULU	HI	96813	01/01/2020
CH053320	PROCARE PHARMACY, L.L.C.	DBA: CVS/PHARMACY #2909	1521 4TH AVE., SOUTH	BIRMINGHAM	AL	35233	01/01/2020
CH053320	PROCARE PHARMACY, L.L.C.	DBA CVS/PHARMACY #2923	3250 HARDEN ST. EXT. SUITE #300	COLUMBIA	SC	29203	10/01/2021
CH053320	REED PHARMACIES, LLC	DBA DICKS PHARMACY	122 S. WALNUT ST	ARTHUR	IL	61911	10/01/2017
CH053320	SHIELDS FAMILY PHARMACY	1 PROFESSIONAL DRIVE STE 170		ALTON	IL	62002	01/01/2018	01/29/2021
CH053320	SIHF HEALTHCARE PHARMACY	SOUTHERN ILLINOIS HEALTHCARE FOUNDATION,	1120 N EAST ST RM 105	OLNEY	IL	62450	01/01/2018	04/16/2018
CH053320	THE PHARMACIE SHOPPE	MOORE FAMILY STORES	202 W EDGAR AVE	CASEY	IL	62420-1024	01/01/2018
CH053320	THE PHARMACIE SHOPPE INC		202 W EDGAR ST	CASEY	IL	62420	07/01/2013	10/11/2017
CH053320	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	10/01/2019
CH053320	WAL-MART PHARMACY 10-0198	1870 WEST MAIN STREET		SALEM	IL	62881	10/01/2019
CH053320	WAL-MART PHARMACY 10-0201	2608 GREEN MOUNT COMMONS DR		BELLEVILLE	IL	62221	10/01/2019
CH053320	WAL-MART PHARMACY 10-0222	1410 NORTH MARKET STREET		SPARTA	IL	62286	10/01/2019
CH053320	WAL-MART PHARMACY 10-0253	1316 SOUTH STATE STREET		JERSEYVILLE	IL	62052	10/01/2019
CH053320	WAL-MART PHARMACY 10-0254	1001 NORTH WEST		OLNEY	IL	62450	10/01/2019
CH053320	WAL-MART PHARMACY 10-0256	400 JUNCTION DR		GLEN CARBON	IL	62034	10/01/2019
CH053320	WAL-MART PHARMACY 10-0317	201 NORTH MATTES AVE		VANDALIA	IL	62471	10/01/2019
CH053320	WAL-MART PHARMACY 10-0328	961 NORTH MARKET STREET		WATERLOO	IL	62298	10/01/2019
CH053320	WAL-MART PHARMACY 10-0352	HWY. 150/2206 STATE STREET		CHESTER	IL	62233	10/01/2019
CH053320	WAL-MART PHARMACY 10-0361	1040 COLLINSVILLE CROSSING		COLLINSVILLE	IL	62234	10/01/2019
CH053320	WAL-MART PHARMACY 10-0436	2591 12TH STREET		CARLYLE	IL	62231	10/01/2019
CH053320	WAL-MART PHARMACY 10-0481	101 DETTRO DRIVE		MATTOON	IL	61938	10/01/2019
CH053320	WAL-MART PHARMACY 10-0506	1540 N WORTHY		FLORA	IL	62839	10/01/2019
CH053320	WAL-MART PHARMACY 10-0550	2610 W. HAVEN RD.		LAWRENCEVILLE	IL	62439	10/01/2019
CH053320	WAL-MART PHARMACY 10-0612	2250 LINCOLN AVE		CHARLESTON	IL	61920	10/01/2019
CH053320	WAL-MART PHARMACY 10-0747	1511 CAMP JACKSON ROAD		CAHOKIA	IL	62206	10/01/2019
CH053320	WAL-MART PHARMACY 10-0936	1204 AVE OF MID AMERICA		EFFINGHAM	IL	62401	10/01/2019
CH053320	WAL-MART PHARMACY 10-1071	610 WESLEY DRIVE		WOOD RIVER	IL	62095	10/01/2019
CH053320	WAL-MART PHARMACY 10-1395	1212 WEST MCCORD		CENTRALIA	IL	62801	10/01/2019
CH053320	WAL-MART PHARMACY 10-1418	1530 WEST HWY 50		O'FALLON	IL	62269	10/01/2019
CH053320	WAL-MART PHARMACY 10-1761	379 WEST PONTOON ROAD		GRANITE CITY	IL	62040	10/01/2019
CH053320	WAL-MART PHARMACY 10-4695	6660 GODFREY RD		GODFREY	IL	62035	10/01/2019
CH053320	WAL-MART PHARMACY 10-5315	2354 COMMERCE PARK DR.		ORLANDO	FL	32819	10/01/2019
CH053320	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	10/01/2019
CH053320	WALGREEN CO	DBA: WALGREENS #12395	6607 STATE ROUTE 162	MARYVILLE	IL	62062	07/01/2019
CH053320	WALGREEN CO	DBA: WALGREENS #10718	1202 W UNION AVE	LITCHFIELD	IL	62056	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 09441	913 N MARKET ST	WATERLOO	IL	62298-1000	10/01/2016
CH053320	WALGREEN CO.	DBA: WALGREENS # 11542	411 W. LINCOLN AVE	CHARLESTON	IL	61920	10/01/2016
CH053320	WALGREEN CO.	DBA: WALGREENS # 05752	1200 W FAYETTE AVE	EFFINGHAM	IL	62401	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 09824	705 SOUTH STATE STREET	JERSEYVILLE	IL	62052	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 06472	4218 LINDELL BLVD	ST LOUIS	MO	63108-2916	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS #09750	1190 COLLINSVILLE CROSSING BLVD.	COLLINSVILLE	IL	62234-1880	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 04671	7501 OLIVE BLVD	UNIVERSITY CITY	MO	63130	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS #10205	640 EDWARDSVILLE RD	TROY	IL	62294	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 01996	1122 VAUGHN RD	WOOD RIVER	IL	62095	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS #11711	1530 LAFAYETTE AVE.	SAINT LOUIS	MO	63104	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS #12303	5939 BELLEVILLE CROSSING STREET	BELLEVILLE	IL	62226	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 03714	2610 STATE ST	ALTON	IL	62002-5150	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 05719	4995 E US ROUTE 36	DECATUR	IL	62521	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 07672	1108 HARTMAN LANE	SHILOH	IL	62221	07/01/2019
CH053320	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #15311	115 N EUCLID AVE STE A	SAINT LOUIS	MO	63108	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 05665	2 COTTONWOOD RD	GLEN CARBON	IL	62034	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 05664	102 W VANDALIA ST	EDWARDSVILLE	IL	62025	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 01309	110 WALNUT STREET	HIGHLAND	IL	62249	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 05608	100 ADMIRAL WEINEL BLVD	COLUMBIA	IL	62236	07/01/2019
CH053320	WALGREEN CO.	DBA: WALGREENS # 07236	225 NORTH ELM STREET	CENTRALIA	IL	62801-3248	07/01/2019
CH053320	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #21190	1150 N 5TH ST STE B	SPRINGFIELD	IL	62702	07/01/2024
CH053320	Walgreens Central Fill #21394	2601 Hughes Road	Suite 103	Liberty	MO	64068	04/01/2023
CH053320	WALGREENS MAIL SERVICE, LLC	WALGREENS MAIL SERVICE #03397	8350 S RIVER PARKWAY	TEMPE	AZ	85284	07/01/2019
CH053320	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2021
CH053320	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/01/2021	10/01/2021
CH053320	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2021
CH053320	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2021
CH053320	WALGREENS.COM, INC.	DBA: WALGREENS	2225 S. PRICE ROAD	CHANDLER	AZ	85286	07/01/2019
CH053320	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH053320	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Profile Change Request	Howard, Patrice M VP of Quality and Performance SIHF Healthcare 6183320694	Howard, Patrice M Senior Vice President SIHF Healthcare 6183320694	2/12/2024 1:05 PM
Details	State	Update		To Be Terminated	Terminated	4/1/2019 12:05 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		12/1/2018 12:00:00 AM	1/9/2019 9:34 AM
Details	State	Update	Termination Request	Active	To Be Terminated	1/9/2019 9:34 AM
Terminations	Termination Date	Update	Termination Request		4/1/2019 12:00:00 AM	1/9/2019 9:34 AM
Terminations	Termination Effective Date	Update	Termination Request		12/1/2018 12:00:00 AM	1/9/2019 9:34 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	1/9/2019 9:34 AM
Details	Last Recertification Date	Update	Recertification	2/9/2017 12:00:00 AM	2/9/2018 6:09:51 PM	2/9/2018 6:09 PM
Addresses	Billing Address	Update	Change Request	SOUTHERN ILLINOIS HEALTHCARE FOUNDATION (SIHF) 8080 STATE STREET EAST ST LOUIS, IL 62203	SIHF Healthcare 2041 Goose Lake Road Sauget, IL 62206	11/7/2017 10:27 AM
Details	Entity Name	Update	Change Request	Southern Illinois Health Care Foundation, Inc.	SIHF Healthcare	11/7/2017 10:27 AM
Contacts	Authorizing Official	Update		McCulley, Larry President 6183320694-155	McCulley, Larry President SIHF Healthcare 6183320694-155	10/11/2017 8:52 AM
Contacts	Primary Contact	Update		Howard, Patrice VP of Quality and Performance 6183320694	Howard, Patrice M VP of Quality and Performance SIHF Healthcare 6183320694	10/10/2017 2:20 PM
Contacts	Authorizing Official	Insert			McCulley, Larry President 6183320694-155	8/11/2017 5:27 PM
Contacts	Primary Contact	Insert			Howard, Patrice VP of Quality and Performance 6183320694	8/11/2017 5:27 PM
Addresses	Main Address	Insert			550 LANDMARKS BLVD ALTON, IL 62002-6321	2/9/2017 2:55 PM
Details	Last Recertification Date	Update		2/18/2016 12:00:00 AM	2/9/2017 12:00:00 AM	2/9/2017 2:55 PM
Details	Last Recertification Date	Update		3/5/2015 12:00:00 AM	2/18/2016 12:00:00 AM	2/18/2016 9:30 AM
Details	Last Recertification Date	Update		2/11/2014 12:00:00 AM	3/5/2015 12:00:00 AM	3/5/2015 12:30 PM
Details	Entity Name	Update		SOUTHERN ILLINOIS HEALTHCARE FOUNDATION (SIHF)	Southern Illinois Health Care Foundation, Inc.	3/31/2014 4:25 PM
Details	Entity Subname	Update		SIHF ALTON HEALTH CENTER	ALTON HEALTH CENTER	3/31/2014 4:25 PM
Details	Last Recertification Date	Update		4/1/2013 12:00:00 AM	2/11/2014 12:00:00 AM	2/11/2014 11:25 AM
Details	Last Recertification Date	Update			4/1/2013 12:00:00 AM	3/15/2013 10:11 AM
Addresses	Billing Address	Insert			SOUTHERN ILLINOIS HEALTHCARE FOUNDATION (SIHF) 8080 STATE STREET EAST ST LOUIS, IL 62203	4/24/2012 4:01 PM
Details	Comments Public	Insert			4/24/12 Changed contact from EDGAR BRANCH. NEW CONTACT INFOR	4/24/2012 4:01 PM
Details	Last Recertification Date	Insert				8/12/2005 3:27 PM
Details	Grant Number	Insert			H80CS00195	8/12/2005 3:27 PM
Details	340B ID	Insert			CH05332F	8/12/2005 3:27 PM
Details	Is Authorizing Official EHB Data	Insert				8/12/2005 3:27 PM
Dates	Last Date That 340B Drugs Purchased	Insert				8/12/2005 3:27 PM
Details	Medicare Provider Number	Insert				8/12/2005 3:27 PM
Details	Entity Name	Insert			SOUTHERN ILLINOIS HEALTHCARE FOUNDATION (SIHF)	8/12/2005 3:27 PM
Details	Program Code	Insert			CH	8/12/2005 3:27 PM
Details	Entity Subname	Insert			SIHF ALTON HEALTH CENTER	8/12/2005 3:27 PM
Dates	Participating Approval Date	Insert			9/30/2004 12:00:00 AM	8/12/2005 3:27 PM
Details	State	Insert			Active	8/12/2005 3:27 PM
Dates	Registration Date	Insert			7/1/2001 12:00:00 AM	8/12/2005 3:27 PM
Dates	Signed By Date	Insert				8/12/2005 3:27 PM
Dates	Start Date	Insert			7/1/2001 12:00:00 AM	8/12/2005 3:27 PM
Terminations	Termination Comments	Insert				8/12/2005 3:27 PM
Terminations	Termination Date	Insert				8/12/2005 3:27 PM
Terminations	Termination Effective Date	Insert				8/12/2005 3:27 PM
Terminations	Termination Reason	Insert				8/12/2005 3:27 PM
Details	Comments Public	Insert			NEW CONTACT INFOR	8/12/2005 3:27 PM

340B Drug Pricing Program Database