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HIGHLAND PARK CVS, L.L.C.
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
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06370
2700 BROADWAY
MOUNT VERNON, IL 62864
Pharmacy Comments
Contract Details
Approval Date
4/8/2020
Contract Begin Date
5/13/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Angela Marie Craig, Controller
(618) 273-3361 Ext: 157
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/8/2020
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