Contract Pharmacy Details

COMMCARE PHARMACY-FTL, LLC
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

COMMCARE PHARMACY-FTL, LLC

Pharmacy Address

855 SW 78TH AVE STE C100
PLANTATION, FL 33324-3223

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

7/10/2019
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Diane L. McGrew, President
(309) 655-2850

Contract Pharmacy Representative

Patty Dodd, Premier
(312) 699-9771

Signed By Date

10/13/2016

340B Drug Pricing Program Database