Contract Pharmacy Details

MERCYONE GENESIS FIRSTMED SPECIALTY PHAR
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

MERCYONE GENESIS FIRSTMED SPECIALTY PHAR

Pharmacy Address

GENVENTURES INC
1227 E RUSHOLME ST
DAVENPORT, IA 52803

Pharmacy Comments

Contract Details

Approval Date

7/1/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Mark Rogers, CFO
(563) 421-6513

Contract Pharmacy Representative

FirstMed Pharmacy
Jason Hansel, FirstMed Pharmacy Manager
(563) 421-2593

Signed By Date

7/1/2020

340B Drug Pricing Program Database