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COUNTY MARKET PHARMACY 228
CHC24098-03 SOUTHERN ILLINOIS UNIVERSITY
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS UNIVERSITY
Subdivision Name
SIU Center for Family Medicine-Jacksonville
Type
HRSA-Funded Health Center
340B ID
CHC24098-03
Entity Address
425 E State Street
Jacksonville, IL 62650
Grant Number
H80CS24098
Participating Start Date
1/1/2017
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
COUNTY MARKET PHARMACY 228
Pharmacy Address
NIEMANN FOODS INC
1903 W MONROE ST
SPRINGFIELD, IL 62704
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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