Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
DSH140067 SAINT FRANCIS MEDICAL CENTER

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

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07800
2540 EAST WASHINGTON ST.
EAST PEORIA, IL 61611

Pharmacy Comments

Contract Details

Approval Date

4/11/2014

Contract Begin Date

7/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

5/20/2022
Pharmacy closed

Contacts

Covered Entity Signing Official

KEVIN D. SCHOEPLEIN, CEO
(309) 655-2850

Contract Pharmacy Representative

CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298

Signed By Date

4/11/2014

340B Drug Pricing Program Database