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HIGHLAND PARK CVS, L.L.C.
CAH141326-00 Hamilton Memorial Hospital District
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Covered Entity Details
Entity Name
Hamilton Memorial Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141326-00
Entity Address
611. S. Marshall Avenue
McLeansboro, IL 62859
Medicare Provider Number
141326
Participating Start Date
7/1/2014
Last Recertification Date
8/23/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06886
1101 W. MAIN ST.
CARMI, IL 62821
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Justin William Epperson, CFO
(618) 643-5848
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2018
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