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HIGHLAND PARK CVS, L.L.C.
DSH140110 OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER D/B/A OSF SAINT ELIZABETH MEDICAL CENTER
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Covered Entity Details
Entity Name
OTTAWA REGIONAL HOSPITAL & HEALTHCARE CENTER D/B/A OSF SAINT ELIZABETH MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140110
Entity Address
1100 EAST NORRIS DRIVE
OTTAWA, IL 61350
Medicare Provider Number
140110
Participating Start Date
7/1/2020
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
CVS/PHARMACY # 10981
110 EAST NORRIS DR
OTTAWA, IL 61350
Pharmacy Comments
Contract Details
Approval Date
7/9/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/9/2021
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