Contract Pharmacy Details

ACCREDO HEALTH GROUP, INC.
RRC140046-00 GOOD SAMARITAN REGIONAL HEALTH CTR.

Covered Entity Details

Entity Name

GOOD SAMARITAN REGIONAL HEALTH CTR.

Subdivision Name

Type

Rural Referral Center

340B ID

RRC140046-00

Entity Address

1 GOOD SAMARITAN WAY
MT. VERNON, IL 62864

Medicare Provider Number

140046

Participating Start Date

10/1/2015

Last Recertification Date

9/14/2022

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

ACCREDO HEALTH GROUP, INC.

Pharmacy Address

4750 E 450 S
SUITE A
WHITESTOWN, IN 46075

Pharmacy Comments

Contract Details

Approval Date

3/16/2022

Contract Begin Date

3/17/2022

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2023
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Jeremy Shawn Bradford, President
(618) 899-1002

Contract Pharmacy Representative

Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500

Signed By Date

3/16/2022

340B Drug Pricing Program Database