Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
RRC140064-00 ST. MARY MEDICAL CENTER

Covered Entity Details

Entity Name

ST. MARY MEDICAL CENTER

Subdivision Name

Type

Rural Referral Center

340B ID

RRC140064-00

Entity Address

3333 N SEMINARY
GALESBURG, IL 61401

Medicare Provider Number

140064

Participating Start Date

7/1/2018

Last Recertification Date

8/26/2021

Entity Termination Date

7/1/2022

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16324
1071 W CARL SANDBURG DR
GALESBURG, IL 61401

Pharmacy Comments

Contract Details

Approval Date

4/15/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Diane L. McGrew, President
(309) 655-2850

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/15/2020

340B Drug Pricing Program Database