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HIGHLAND PARK CVS, L.L.C.
CAH141345-00 Salem Township Hospital
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Covered Entity Details
Entity Name
Salem Township Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141345-00
Entity Address
1201 Ricker Drive
Salem, IL 62881
Medicare Provider Number
141345
Participating Start Date
4/1/2013
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06388
801 W. MAIN ST.
MARION, IL 62959
Pharmacy Comments
Contract Details
Approval Date
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Alexander Nazarian, CEO
(618) 740-1647
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/14/2021
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