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MORELAND AND DEVITT, INC.
CAH141333-01 Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital
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Covered Entity Details
Entity Name
Schuyler County Hospital District dba Sarah D. Culbertson Memorial Hospital
Subdivision Name
SCHUYLER COUNTY HOSPITAL DISTRICT - Elmer Hugh Taylor Clinic
Type
Critical Access Hospital
340B ID
CAH141333-01
Entity Address
100W 15TH ST
BEARDSTOWN, IL 62618-1774
Medicare Provider Number
141333
Outpatient Facility Provider Number
143483
Participating Start Date
7/1/2018
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MORELAND AND DEVITT, INC.
Pharmacy Address
200 N. PITTSFIELD RD.
STE B
MT STERLING, IL 62353
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tamra S Gadberry, Chief Financial Officer
(217) 322-5296
Contract Pharmacy Representative
Moreland and Deavitt
Garry Moreland, Pharmacist
(217) 322-3335
Signed By Date
7/17/2018
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