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HIGHLAND PARK CVS, L.L.C.
CAH141321-00 Franklin Hospital District
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Covered Entity Details
Entity Name
Franklin Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141321-00
Entity Address
201 Bailey Lane
Benton, IL 62812-1999
Medicare Provider Number
141321
Participating Start Date
1/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA CVS/PHARMACY #18091
1129 W BROADWAY
CENTRALIA, IL 62801
Pharmacy Comments
Contract Details
Approval Date
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rikki S. Bonthron, CFO
(618) 439-3161 Ext: 9601
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/14/2021
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