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CAIN'S DRUG STORE
CAH141346-00 Sarah Bush Lincoln Fayette County Hospital
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Covered Entity Details
Entity Name
Sarah Bush Lincoln Fayette County Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141346-00
Entity Address
650 W. Taylor Street
VANDALIA, IL 62471
Medicare Provider Number
141346
Participating Start Date
1/1/2023
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
CAIN'S DRUG STORE
Pharmacy Address
1401 N 8TH ST
VANDALIA, IL 62471-1028
Pharmacy Comments
Contract Details
Approval Date
11/22/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gregory D. Starnes, Chief Executive Officer
(618) 283-5400
Contract Pharmacy Representative
Bond County Pharmacy
Darryl Tjaden, Owner/Pharmacist
(618) 283-0196
Signed By Date
11/22/2022
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