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EDS MEDICENTER PHARMACY
CAH141311-00 FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
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Covered Entity Details
Entity Name
FAIRFIELD MEMORIAL HOSPITAL ASSOCIATION
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141311-00
Entity Address
303 NW 11TH STREET
FAIRFIELD, IL 62837
Medicare Provider Number
141311
Participating Start Date
7/1/2011
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
EDS MEDICENTER PHARMACY
Pharmacy Address
SESSER PHARMACY SI LLC
1116 W MAIN ST
FAIRFIELD, IL 62837-2324
Pharmacy Comments
Contract Details
Approval Date
1/7/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/22/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
Amy Marsh, CHIEF FINANCIAL OFFICER
(618) 847-8260
Contract Pharmacy Representative
EDS MEDICENTER PHARMACY
Steve Sommer, Manager Contracting & Channel Management
(618) 826-2511
Signed By Date
1/7/2019
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