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M.N. 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
M.N. PHARMACY LLC
Pharmacy Address
DBA AMAZON PHARMACY #003
6701 NW 7TH ST., STE. #199
MIAMI, FL 33126
Pharmacy Comments
Contract Details
Approval Date
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Stephen Douglas McGill, CFO
(618) 263-6305
Contract Pharmacy Representative
PillPack, Inc.
Geoff Swindle, Administrator
(855) 745-5725
Signed By Date
7/17/2018
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