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PLUM STREET PHARMACY LLC
CAH141324-00 Ferrell Hospital Community Foundation dba Ferrell Hospital
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Covered Entity Details
Entity Name
Ferrell Hospital Community Foundation dba Ferrell Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141324-00
Entity Address
1201 Pine Street
Eldorado, IL 62930
Medicare Provider Number
141324
Participating Start Date
4/1/2012
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
PLUM STREET PHARMACY LLC
Pharmacy Address
311 PLUM ST
CARMI, IL 62821
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Charlie Frederick Will, Controller
(618) 297-9629
Contract Pharmacy Representative
Plum Street Pharmacy
Andy Gee, Owner
(618) 382-3784
Signed By Date
7/15/2019
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