Contract Pharmacy Details

MEDEX PHARMACY 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

MEDEX PHARMACY INC

Pharmacy Address

1704 NORTH ILLINOIS
SWANSEA, IL 62226-3948

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

2/22/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Richard Sprehe, Owner
(618) 236-1144

Signed By Date

4/3/2013