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MEDICATE PHARMACY
HV05332F SIHF Healthcare
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Covered Entity Details
Entity Name
SIHF Healthcare
Subdivision Name
SIHF Healthcare - Alton
Type
Ryan White Part C
340B ID
HV05332F
Entity Address
4 Memorial Drive
Building B, Suite210
Alton, IL 62002
Grant Number
H76HA00579
Participating Start Date
7/1/2005
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
7/15/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/12/2017
Business decision by covered entity and/or pharmacy
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
7/15/2015
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