Contract Pharmacy Details

AMERICAN DRUG STORES LLC
DSH140029 COPLEY MEMORIAL HOSPITAL

Covered Entity Details

Entity Name

COPLEY MEMORIAL HOSPITAL

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140029

Entity Address

2000 OGDEN AVENUE
AURORA, IL 60504

Medicare Provider Number

140029

Participating Start Date

4/1/2008

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

AMERICAN DRUG STORES LLC

Pharmacy Address

DBA OSCO DRUG 3331
2038 PRAIRIE ST.
ST CHARLES, IL 60174

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/27/2021
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Brenda VanWyhe, SENIOR VP FINANCE AND CFO
(630) 898-3565

Contract Pharmacy Representative

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

7/15/2020

340B Drug Pricing Program Database