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NOBLE HEALTH SERVICES, INC.
CAH141338-00 Memorial Hospital
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Covered Entity Details
Entity Name
Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141338-00
Entity Address
1900 State Street
Chester, IL 62233
Medicare Provider Number
141338
Participating Start Date
4/1/2012
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
NOBLE HEALTH SERVICES, INC.
Pharmacy Address
DBA TRANSCRIPT PHARMACY
2506 LAKELAND DR
STE 201
FLOWOOD, MS 39232-7656
Pharmacy Comments
Contract Details
Approval Date
10/4/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brett Bollmann, Chief Executive Officer
(618) 826-4581 Ext: 1298
Contract Pharmacy Representative
KPH Healthcare Services, Inc.
Debbi Barber, 340B Program Director
(315) 287-3600 Ext: 2423
Signed By Date
10/4/2022
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