340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
OSF HOME INFUSION PHARMACY
CAH141310-00 Mendota Community Hospital d/b/a OSF Saint Paul Medical Center
Print
Covered Entity Details
Entity Name
Mendota Community Hospital d/b/a OSF Saint Paul Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141310-00
Entity Address
1401 E. 12th St.
MENDOTA, IL 61342
Medicare Provider Number
141310
Participating Start Date
1/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
OSF HOME INFUSION PHARMACY
Pharmacy Address
2265 W ALTORFER DR
PEORIA, IL 61615-1807
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
1/10/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
OSF Healthcare
Kelly J Taylor, Manager Pharmacy
(309) 624-5464
Signed By Date
7/9/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session