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HIGHLAND PARK CVS, L.L.C.
CHC24098-04 SOUTHERN ILLINOIS UNIVERSITY
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine-Lincoln
Type
HRSA-Funded Health Center
340B ID
CHC24098-04
Entity Address
109 3rd Street
Lincoln, IL 62656
Grant Number
H80CS24098
Participating Start Date
7/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06820
534 WOODLAWN RD.
LINCOLN, IL 62656
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Iris Elenora Wesley, CEO
(217) 757-8116
Contract Pharmacy Representative
SIU Center for Family Medicine
Michael Black, CFO
(217) 747-6470
Signed By Date
7/15/2024
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