340B Drug Pricing Program Database
HIGHLAND PARK CVS, L.L.C.
CAH141345-00 Salem Township Hospital - information as of 4/25/2025 9:02:41 PM
Covered Entity Details
Entity Name
Salem Township Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141345-00
Entity Address
1201 Ricker Drive
Salem, IL 62881
Medicare Provider Number
141345
Participating Start Date
4/1/2013
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06370
2700 BROADWAY
MOUNT VERNON, IL 62864
Pharmacy Comments
Contract Details
Approval Date
10/14/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kendra Kae Taylor, President/CEO
(618) 548-3194
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/14/2020
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