340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
WISCONSIN CVS PHARMACY, L.L.C.
DSH140228 SWEDISH AMERICAN HOSPITAL
Print
Covered Entity Details
Entity Name
SWEDISH AMERICAN HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140228
Entity Address
1401 E STATE ST
ROCKFORD, IL 61104
Medicare Provider Number
140228
Participating Start Date
9/9/2005
Last Recertification Date
8/28/2024
Pharmacy Details
Pharmacy Name
WISCONSIN CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05600
2149 PRAIRIE AVE.
BELOIT, WI 53511
Pharmacy Comments
Contract Details
Approval Date
9/24/2020
Contract Begin Date
9/25/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia A. DeWane, Vice President, Finance and Treasurer
(779) 696-4727
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
9/24/2020
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session