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HUDSON DRUG SHOP
CHC29834-02 PROMISE HEALTHCARE NFP
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Covered Entity Details
Entity Name
PROMISE HEALTHCARE NFP
Subdivision Name
Promise Healthcare at the Community Resource Center
Type
HRSA-Funded Health Center
340B ID
CHC29834-02
Entity Address
1400 W. Park, Building #3
Urbana, IL 61801-2334
Grant Number
H80CS29834
Participating Start Date
10/1/2016
Last Recertification Date
1/29/2020
Entity Termination Date
1/1/2021
Pharmacy Details
Pharmacy Name
HUDSON DRUG SHOP
Pharmacy Address
108 N MARKET ST
PO BOX 70
PAXTON, IL 60957-1220
Pharmacy Comments
Contract Details
Approval Date
7/14/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Nancy Greenwalt, Executive Director
(217) 403-5401
Contract Pharmacy Representative
Hudson Drug Shop
Andy Hudson, President
(217) 379-4858
Signed By Date
7/14/2019
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