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DICKS PHARMACY
SCH140189-00 SARAH BUSH LINCOLN HEALTH CENTER
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Covered Entity Details
Entity Name
SARAH BUSH LINCOLN HEALTH CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140189-00
Entity Address
1000 HEALTH CENTER DRIVE
MATTOON, IL 61938
Medicare Provider Number
140189
Participating Start Date
7/1/2018
Last Recertification Date
9/4/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
DICKS PHARMACY
Pharmacy Address
WOOD, BRUCE DENE
118 S. VINE
ARTHUR, IL 61911
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/11/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Bob O'Rourke, Chief Accounting Officer
(217) 258-2591
Contract Pharmacy Representative
Dick's Pharmacy
Cindi Reed, Owner/PIC
(217) 543-2913
Signed By Date
4/17/2023
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