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MEDICATE CENTRAL PHARMACY
CH05332AM SIHF Healthcare
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Covered Entity Details
Entity Name
SIHF Healthcare
Subdivision Name
SIHF Healthcare - Fairmont City
Type
HRSA-Funded Health Center
340B ID
CH05332AM
Entity Address
2568 N 41ST ST
FAIRMONT, IL 62201-2204
Grant Number
H80CS00195
Participating Start Date
10/1/2004
Last Recertification Date
2/22/2025
Pharmacy Details
Pharmacy Name
MEDICATE CENTRAL PHARMACY
Pharmacy Address
1833 KINGSHIGHWAY
SUITE 100
WASHINGTON PARK, IL 62204-2135
Pharmacy Comments
Contract Details
Approval Date
3/24/2006
Contract Begin Date
3/24/2006
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
3/20/2006
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