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HIGHLAND PARK CVS, L.L.C.
CAH141343-00 CRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
CRAWFORD HOSPITAL DISTRICT D/B/A CRAWFORD MEMORIAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141343-00
Entity Address
1000 N. ALLEN STREET
ROBINSON, IL 62454
Medicare Provider Number
141343
Participating Start Date
1/1/2011
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06386
1421 STATE ST.
LAWRENCEVILLE, IL 62439
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MITZI MARTIN, BOARD VICE CHAIR
(618) 544-3131 Ext: 5123
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/11/2023
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