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MEDICATE PHARMACY
HV053320 SIHF Healthcare
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Covered Entity Details
Entity Name
SIHF Healthcare
Subdivision Name
ADMINISTRATIVE OFFICE
Type
Ryan White Part C
340B ID
HV053320
Entity Address
100 North 8th Street
Suite 238
East St. Louis, IL 62201
Grant Number
H76HA00579
Participating Start Date
7/1/2005
Last Recertification Date
2/22/2025
Pharmacy Details
Pharmacy Name
MEDICATE PHARMACY
Pharmacy Address
100 N 8TH ST STE 100
EAST SAINT LOUIS, IL 62201-2989
Pharmacy Comments
Contract Details
Approval Date
10/13/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry McCulley, President
(618) 332-0694 Ext: 155
Contract Pharmacy Representative
Medicate Pharmacy
Michael Shaltenbrand, President
(618) 875-1000
Signed By Date
10/13/2020
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