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HIGHLAND PARK CVS, L.L.C.
SCH140064-00 ST. MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. MARY MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140064-00
Entity Address
3333 N SEMINARY
GALESBURG, IL 61401
Medicare Provider Number
140064
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16324
1071 W CARL SANDBURG DR
GALESBURG, IL 61401
Pharmacy Comments
Contract Details
Approval Date
7/6/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/6/2022
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