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WAL-MART PHARMACY 10-1421
DSH140067 SAINT FRANCIS MEDICAL CENTER
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Covered Entity Details
Entity Name
SAINT FRANCIS MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140067
Entity Address
530 NE GLEN OAK AVENUE
PEORIA, IL 61637
Medicare Provider Number
140067
Participating Start Date
10/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1421
Pharmacy Address
1980 FREEDOM PARKWAY
WASHINGTON, IL 61571
Pharmacy Comments
Contract Details
Approval Date
4/7/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/29/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
KEVIN D. SCHOEPLEIN, CEO
(309) 655-2850
Contract Pharmacy Representative
Healdsburg District Hospital
Kathi Phelps, Manager Contracting
(479) 277-3719
Signed By Date
4/7/2014
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