Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
SCH140189-00 SARAH BUSH LINCOLN HEALTH CENTER

Covered Entity Details

Entity Name

SARAH BUSH LINCOLN HEALTH CENTER

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH140189-00

Entity Address

1000 HEALTH CENTER DRIVE
MATTOON, IL 61938

Medicare Provider Number

140189

Participating Start Date

7/1/2018

Last Recertification Date

9/4/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08667
1818 SOUTH PHILO RD
URBANA, IL 61802

Pharmacy Comments

Contract Details

Approval Date

7/9/2019

Contract Begin Date

10/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

3/9/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Jerry Esker, President & CEO
(217) 258-2540

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/9/2019

340B Drug Pricing Program Database