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DELIVERCARERX PHARMACY LLC
CAH141327-00 Wabash General Hospital District
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Covered Entity Details
Entity Name
Wabash General Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141327-00
Entity Address
1418 College Drive
Mt Carmel, IL 62863
Medicare Provider Number
141327
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
DELIVERCARERX PHARMACY LLC
Pharmacy Address
DELIVERCARERX PHARMACY LLC
1471 E BUSINESS CENTER DR
STE 200
MT PROSPECT, IL 60056
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
Stephen Douglas McGill, CFO
(618) 263-6305
Contract Pharmacy Representative
Agape
Dave Krishna, CEO
(847) 965-1600
Signed By Date
7/17/2018
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