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MEDI-PARK PHARMACY
CH051833A Heartland Community Health Clinic DBA: Heartland Health Services
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Covered Entity Details
Entity Name
Heartland Community Health Clinic DBA: Heartland Health Services
Subdivision Name
Garden
Type
HRSA-Funded Health Center
340B ID
CH051833A
Entity Address
1701 W Garden St
Peoria, IL 61605
Grant Number
H80CS02457
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MEDI-PARK PHARMACY
Pharmacy Address
420 NE GLEN OAK AVE STE 102
HILLCREST PLAZA
PEORIA, IL 61603-3171
Pharmacy Comments
Contract Details
Approval Date
7/12/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHARLES BANDOIAN, CEO
(309) 680-7657
Contract Pharmacy Representative
OSF
Tom Terrell, Pharmacy Manager
(309) 655-3799
Signed By Date
7/12/2018
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