Contract Pharmacy Details

MEDICATE PHARMACY
CH05332T SIHF Healthcare

Covered Entity Details

Entity Name

SIHF Healthcare

Subdivision Name

SIHF Healthcare - Granite City

Type

HRSA-Funded Health Center

340B ID

CH05332T

Entity Address

2166 Madison Ave
Granite City, IL 62040-4700

Grant Number

H80CS00195

Participating Start Date

10/1/2004

Last Recertification Date

2/22/2025

Pharmacy Details

Pharmacy Name

MEDICATE PHARMACY

Pharmacy Address

2166 MADISON AVE
GRANITE CITY, IL 62040

Pharmacy Comments

Contract Details

Approval Date

7/6/2015

Contract Begin Date

10/1/2015

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Larry McCulley, President
(618) 332-0694 Ext: 155

Contract Pharmacy Representative

Michael Schaltenbrand, Owner
(618) 709-7520

Signed By Date

7/6/2015