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WALGREEN CO.
CAH141307-00 PINCKNEYVILLE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
PINCKNEYVILLE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141307-00
Entity Address
5383 STATE ROUTE 154
PINCKNEYVILLE, IL 62274
Medicare Provider Number
141307
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA WALGREENS SPECIALTY PHARMACY #21346
3527 CHOUTEAU AVE
SAINT LOUIS, MO 63103
Pharmacy Comments
Contract Details
Approval Date
10/3/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KARA JO CARSON, CFO
(618) 357-2187 Ext: 5902
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
10/3/2018
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