Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
RRC150082-00 DEACONESS HOSPITAL

Covered Entity Details

Entity Name

DEACONESS HOSPITAL

Subdivision Name

Type

Rural Referral Center

340B ID

RRC150082-00

Entity Address

600 MARY STREET
EVANSVILLE, IN 47747

Medicare Provider Number

150082

Participating Start Date

10/20/2021

Last Recertification Date

8/14/2024

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06887
915 N. MARKET ST.
MOUNT CARMEL, IL 62863

Pharmacy Comments

Contract Details

Approval Date

10/20/2021

Contract Begin Date

10/20/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/21/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Cheryl Wathen, Chief Financial Officer
(812) 450-3296

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/12/2021

340B Drug Pricing Program Database