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HIGHLAND PARK CVS, L.L.C.
DSH140228 SWEDISH AMERICAN HOSPITAL
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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
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08530
6506 ALPINE RD.
LOVES PARK, IL 61111
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
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