Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
DSH140275 GENESIS MEDICAL CENTER - SILVIS

Covered Entity Details

Entity Name

GENESIS MEDICAL CENTER - SILVIS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140275

Entity Address

801 Illini Drive
Silvis, IL 61282

Medicare Provider Number

140275

Participating Start Date

1/1/2019

Last Recertification Date

8/14/2023

Entity Termination Date

1/1/2024

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 08634
910 W. 4TH ST.
MILAN, IL 61264

Pharmacy Comments

Contract Details

Approval Date

7/9/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/31/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Theresa Main, GMC Silvis President
(309) 281-5146

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

7/9/2021

340B Drug Pricing Program Database