Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
SCH140001-00 GRAHAM HOSPITAL ASSOCIATION

Covered Entity Details

Entity Name

GRAHAM HOSPITAL ASSOCIATION

Subdivision Name

Type

Sole Community Hospital

340B ID

SCH140001-00

Entity Address

210 W. Walnut Street
Canton, IL 61520

Medicare Provider Number

140001

Participating Start Date

7/1/2015

Last Recertification Date

8/26/2024

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06446
1008 W. GARFIELD ST
BARTONVILLE, IL 61607

Pharmacy Comments

Contract Details

Approval Date

7/15/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Holly Henline, VP of Ancillary Services & Corporate Compliance Officer
(309) 647-5240 Ext: 2709

Contract Pharmacy Representative

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

Signed By Date

7/15/2020

340B Drug Pricing Program Database