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MORELAND AND DEVITT INC
CAH141333-02 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 Community Medical Clinic Astoria - Rural Health Clinic
Type
Critical Access Hospital
340B ID
CAH141333-02
Entity Address
135 W Broadway
Astoria, IL 61501
Medicare Provider Number
141333
Outpatient Facility Provider Number
143484
Participating Start Date
10/1/2018
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MORELAND AND DEVITT INC
Pharmacy Address
124 N CONGRESS ST
P.O. BOX 319
RUSHVILLE, IL 62681
Pharmacy Comments
Contract Details
Approval Date
7/26/2018
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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