Contract Pharmacy Details

THE PHARMACIE SHOPPE INC
CH053320 SIHF Healthcare

Covered Entity Details

Entity Name

SIHF Healthcare

Subdivision Name

SIHF Healthcare

Type

HRSA-Funded Health Center

340B ID

CH053320

Entity Address

2041 Goose Lake Rd,
Sauget, IL 62206-2822

Grant Number

H80CS00195

Participating Start Date

7/1/2001

Last Recertification Date

2/26/2025

Pharmacy Details

Pharmacy Name

THE PHARMACIE SHOPPE INC

Pharmacy Address

202 W EDGAR ST
CASEY, IL 62420

Pharmacy Comments

Contract Details

Approval Date

4/3/2013

Contract Begin Date

7/1/2013

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/11/2017
Ownership change

Contacts

Covered Entity Signing Official

Larry McCulley, President
(618) 332-0694 Ext: 155

Contract Pharmacy Representative

Adam West, Pharmacy Manager
(217) 932-4004

Signed By Date

4/3/2013