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NIV ACQUISITION LLC
CHC24098-09 SOUTHERN ILLINOIS UNIVERSITY
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine-Transitions of Western Illinois
Type
HRSA-Funded Health Center
340B ID
CHC24098-09
Entity Address
4409 Maine St, Suite 100
Quincy, IL 62305
Grant Number
H80CS24098
Participating Start Date
7/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
NIV ACQUISITION LLC
Pharmacy Address
DBA OMNICARE OF QUINCY
1114 BROADWAY
QUINCY, IL 62301
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Iris Elenora Wesley, CEO
(217) 757-8116
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/16/2023
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