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HIGHLAND PARK CVS, L.L.C.
DSH160033 GENESIS MEDICAL CENTER - DAVENPORT
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Covered Entity Details
Entity Name
GENESIS MEDICAL CENTER - DAVENPORT
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH160033
Entity Address
1227 EAST RUSHOLME
DAVENPORT, IA 52803
Medicare Provider Number
160033
Participating Start Date
1/1/2019
Last Recertification Date
8/21/2024
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
7/12/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jordan Voigt, GMC Davenport President
(563) 421-2792
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2021
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