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NAUVOO PHARMACY PLLC
CAH141305-00 Memorial Hospital Association
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Covered Entity Details
Entity Name
Memorial Hospital Association
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141305-00
Entity Address
1454 North Co Road 2050 East
Carthage, IL 62321
Medicare Provider Number
141305
Participating Start Date
1/1/2013
Last Recertification Date
8/22/2024
Pharmacy Details
Pharmacy Name
NAUVOO PHARMACY PLLC
Pharmacy Address
1350 MULHOLLAND ST
NAUVOO, IL 62354
Pharmacy Comments
Contract Details
Approval Date
7/14/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Teresa Smith, CFO
(217) 357-8573
Contract Pharmacy Representative
Nauvoo Pharmacy
LuAnn Haas, R. PH./ Owner
(217) 453-2717
Signed By Date
7/14/2023
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