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HUDSON DRUG SHOP
CHC29834-04 PROMISE HEALTHCARE
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Covered Entity Details
Entity Name
PROMISE HEALTHCARE
Subdivision Name
Promise Healthcare - Rantoul
Type
HRSA-Funded Health Center
340B ID
CHC29834-04
Entity Address
424 E Wabash Ave
Rantoul, IL 61866-3013
Grant Number
H80CS29834
Participating Start Date
4/1/2024
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HUDSON DRUG SHOP
Pharmacy Address
108 N MARKET ST
PO BOX 70
PAXTON, IL 60957-1220
Pharmacy Comments
Contract Details
Approval Date
1/10/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Henry, Promise Healthcare Executive Director
(217) 403-5401
Contract Pharmacy Representative
Hudson Drug Shop
Andy Hudson, President
(217) 379-4858
Signed By Date
1/10/2024
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