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ACCREDO HEALTH GROUP, INC.
DSH140164B MEMORIAL HOSPITAL OF CARBONDALE
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Covered Entity Details
Entity Name
MEMORIAL HOSPITAL OF CARBONDALE
Subdivision Name
Cancer Treatment Center - Infusion
Type
Disproportionate Share Hospital
340B ID
DSH140164B
Entity Address
1400 Pin Oak Drive
Carterville, IL 62918
Medicare Provider Number
140164
Outpatient Facility Provider Number
Participating Start Date
1/1/2016
Last Recertification Date
9/5/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
10/17/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
REX BUDDE, CEO
(618) 457-5200
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
10/17/2022
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