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SULLIVAN DRUGS OF LITCHFIELD INC
CHC22690-01 MACOUPIN, COUNTY OF
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Covered Entity Details
Entity Name
MACOUPIN, COUNTY OF
Subdivision Name
Macoupin County Public Health Clinic Site
Type
HRSA-Funded Health Center
340B ID
CHC22690-01
Entity Address
1115 E. Morgan Street
Carlinville, IL 62626-1430
Grant Number
H80CS22690
Participating Start Date
1/1/2020
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
SULLIVAN DRUGS OF LITCHFIELD INC
Pharmacy Address
320 E UNION AVE
LITCHFIELD, IL 62056
Pharmacy Comments
Contract Details
Approval Date
10/11/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kent Tarro, CEO
(217) 825-6705
Contract Pharmacy Representative
Sullivans Drugs
Maurice Sullivan, CEO
(217) 839-2909
Signed By Date
10/11/2019
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