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AMERICAN DRUG STORES LLC
DSH140275 GENESIS MEDICAL CENTER - SILVIS
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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 3770
107 AVENUE OF THE CITIES
EAST MOLINE, IL 61244
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
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