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BOND COUNTY PHARMACY, LLC
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
BOND COUNTY PHARMACY, LLC
Pharmacy Address
224A E HARRIS AVE
GREENVILLE, IL 62246
Pharmacy Comments
Contract Details
Approval Date
11/22/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/1/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Gregory D. Starnes, Chief Executive Officer
(618) 283-5400
Contract Pharmacy Representative
Bond County Pharmacy LLC
Scott Borntreger, Co-Owner
(618) 690-5000
Signed By Date
11/22/2022
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