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CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
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
CAREMARK ILLINOIS SPECIALTY PHARMACY, LL
Pharmacy Address
DBA CVS/SPECIALTY OR CARELONRX SPECIALTY
800 BIERMANN CT STE B
MOUNT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
10/13/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/31/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
CVS Health
Kevin Chinn, Director, Health Alliance Development
(858) 260-1446
Signed By Date
10/13/2016
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