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CARLINVILLE HEALTH & PRESCRIPTION INC.
CHC22690-02 MACOUPIN, COUNTY OF
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Covered Entity Details
Entity Name
MACOUPIN, COUNTY OF
Subdivision Name
Columbian Boulevard Dental Clinic
Type
HRSA-Funded Health Center
340B ID
CHC22690-02
Entity Address
125 W Columbian Blvd S
Litchfield, IL 62056-3021
Grant Number
H80CS22690
Participating Start Date
7/1/2021
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
CARLINVILLE HEALTH & PRESCRIPTION INC.
Pharmacy Address
D/B/A SULLIVAN DRUGS OF CARLINVILLE
920 W MAIN ST
DBA SULLIVAN DRUGS
CARLINVILLE, IL 62626
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
Lori J Sanson, CFO
(217) 930-2282
Contract Pharmacy Representative
Sullivans Drugs
Maurice Sullivan, CEO
(217) 839-2909
Signed By Date
7/15/2024
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