Contract Pharmacy Details

AMERICAN DRUG STORES LLC
DSH140275 GENESIS MEDICAL CENTER - SILVIS

Covered Entity Details

Entity Name

GENESIS MEDICAL CENTER - SILVIS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140275

Entity Address

801 Illini Drive
Silvis, IL 61282

Medicare Provider Number

140275

Participating Start Date

1/1/2019

Last Recertification Date

8/14/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

AMERICAN DRUG STORES LLC

Pharmacy Address

DBA OSCO DRUG 122
2010 1ST ST STE A
MOLINE, IL 61265

Pharmacy Comments

Contract Details

Approval Date

10/11/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/13/2020
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Mark Rogers, CFO
(563) 421-6513

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

10/11/2019

340B Drug Pricing Program Database