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NIEMANN FOODS INC
CHC24098-18 SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Subdivision Name
SIU Center for Healthy Aging and Wellness
Type
HRSA-Funded Health Center
340B ID
CHC24098-18
Entity Address
319 E. Madison St. STE 1F
Springfield, IL 62701-3118
Grant Number
H80CS24098
Participating Start Date
7/1/2023
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
NIEMANN FOODS INC
Pharmacy Address
COUNTY MARKET PHARMACY 225
210 E CARPENTER ST
SPRINGFIELD, IL 62702
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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