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RIVERVIEW PHARMACY INC
DSH140186 RIVERSIDE MEDICAL CENTER
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Covered Entity Details
Entity Name
RIVERSIDE MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140186
Entity Address
350 N Wall Street
KANKAKEE, IL 60901
Medicare Provider Number
140186
Participating Start Date
1/1/2007
Last Recertification Date
8/16/2024
Pharmacy Details
Pharmacy Name
RIVERVIEW PHARMACY INC
Pharmacy Address
475 BROWN BLVD STE 105
#105
BOURBONNAIS, IL 60914-2325
Pharmacy Comments
Contract Details
Approval Date
4/2/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patricia K. Vilt, Chief Financial Officer
(815) 935-7542 Ext: 37219
Contract Pharmacy Representative
Riverview Pharmacy
John Hall, Owner
(815) 933-1735
Signed By Date
4/2/2021
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