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5 GUYS RX II, LLC
CH053320 SIHF Healthcare
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Covered Entity Details
Entity Name
SIHF Healthcare
Subdivision Name
SIHF Healthcare
Type
HRSA-Funded Health Center
340B ID
CH053320
Entity Address
2041 Goose Lake Rd,
Sauget, IL 62206-2822
Grant Number
H80CS00195
Participating Start Date
7/1/2001
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
5 GUYS RX II, LLC
Pharmacy Address
DBA WELLCREEK PHARMACY-CHARLESTON
1 W LINCOLN AVE
CHARLESTON, IL 61920-3016
Pharmacy Comments
Contract Details
Approval Date
1/16/2022
Contract Begin Date
4/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry McCulley, President
(618) 332-0694 Ext: 155
Contract Pharmacy Representative
5 Guys RX II, LLC
Tal Rozren, Owner
(217) 512-2816
Signed By Date
1/16/2022
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