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ACCREDO HEALTH GROUP, INC.
DSH140209 METHODIST MEDICAL CENTER OF ILLINOIS
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Covered Entity Details
Entity Name
METHODIST MEDICAL CENTER OF ILLINOIS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140209
Entity Address
221 NE GLEN OAK AVE.
PEORIA, IL 61636
Medicare Provider Number
140209
Participating Start Date
10/1/2006
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
4750 E 450 S
SUITE A
WHITESTOWN, IN 46075
Pharmacy Comments
Contract Details
Approval Date
7/24/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Keith E. Knepp, CEO
(309) 671-2528
Contract Pharmacy Representative
Accredo Specialty Pharmacy
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500
Signed By Date
7/24/2023
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