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HIGHLAND PARK CVS, L.L.C.
CAH141317-00 GIBSON COMMUNITY HOSPITAL DBA GIBSON AREA HOSPITAL AND HEALTH SERVICES
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Covered Entity Details
Entity Name
GIBSON COMMUNITY HOSPITAL DBA GIBSON AREA HOSPITAL AND HEALTH SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141317-00
Entity Address
1120 N MELVIN
GIBSON CITY, IL 60936
Medicare Provider Number
141317
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06679
300 E. WALNUT ST.
WATSEKA, IL 60970
Pharmacy Comments
Contract Details
Approval Date
1/15/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Ertel, CFO
(217) 784-2601
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2021
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