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MEDICAP PHARMACY
CH052180 RURAL HEALTH, INC.
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Covered Entity Details
Entity Name
RURAL HEALTH, INC.
Subdivision Name
ANNA MEDICAL CLINIC
Type
HRSA-Funded Health Center
340B ID
CH052180
Entity Address
513 NORTH MAIN STREET
ANNA, IL 62906
Grant Number
H80CS00711
Participating Start Date
10/1/1998
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
MEDICAP PHARMACY
Pharmacy Address
1785 E. VIENNA ST.
P O BOX 683
ANNA, IL 62906
Pharmacy Comments
Contract Details
Approval Date
1/8/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Cindy Flamm, CEO
(618) 833-4471 Ext: 1015
Contract Pharmacy Representative
340B Direct
Matthew Werfelmann, Executive Account Director
(801) 326-3147
Signed By Date
1/8/2021
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