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MEDICINE EXPRESS
HV05332T SIHF Healthcare
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Covered Entity Details
Entity Name
SIHF Healthcare
Subdivision Name
SIHF Healthcare - Granite City
Type
Ryan White Part C
340B ID
HV05332T
Entity Address
2166 Madison Ave
Granite City, IL 62040
Grant Number
H76HA00579
Participating Start Date
7/1/2005
Last Recertification Date
2/22/2025
Pharmacy Details
Pharmacy Name
MEDICINE EXPRESS
Pharmacy Address
1704 NORTH ILLINOIS
SUITE 200
SWANSEA, IL 62226
Pharmacy Comments
Contract Details
Approval Date
7/1/2005
Contract Begin Date
7/1/2005
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/22/2019
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/8/2005
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