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HIGHLAND PARK CVS, L.L.C.
CHC24098-00 SOUTHERN ILLINOIS UNIVERSITY
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine
Type
HRSA-Funded Health Center
340B ID
CHC24098-00
Entity Address
520 N 4th St
Springfield, IL 62702-5238
Grant Number
H80CS24098
Participating Start Date
1/1/2013
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06373
304 W. MAIN ST.
WEST FRANKFORT, IL 62896
Pharmacy Comments
Contract Details
Approval Date
1/11/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/11/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Iris Elenora Wesley, CEO
(217) 757-8116
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2022
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