340B Drug Pricing Program Database
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CAH141304-08 Genesis Medical Center, Aledo (Terminated)
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Main Details
Name
Genesis Medical Center, Aledo
Subdivision Name
Medical Associates Clinic - Santiago
Type
Critical Access Hospital
Rural
Yes
340B ID
CAH141304-08
Medicare Provider Number
141304
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2013
Participating Start Date
4/1/2013
Participating Approval Date
3/5/2013
Last Recertification Date
11/21/2017
Termination Date
Termination Reason
10/1/2018
Business decision by the Covered Entity
Contacts
Authorizing Official
Genesis Medical Center Aledo
Edward Rogalski, Administrator
(309) 582-3700
Primary Contact
Genesis Medical Center Aledo
John Philibert, Pharmacy Manager
(309) 582-9184
Addresses
Street Address
409 NW 9th Avenue
Aledo, IL 61231
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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