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MAXWELL PHARMACY, INC.
SCH140015-00 BLESSING HOSPITAL
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Covered Entity Details
Entity Name
BLESSING HOSPITAL
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140015-00
Entity Address
1005 BROADWAY
QUINCY, IL 62301
Medicare Provider Number
140015
Participating Start Date
3/16/2021
Last Recertification Date
8/13/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
MAXWELL PHARMACY, INC.
Pharmacy Address
200 S 9TH ST
HANNIBAL, MO 63401-4203
Pharmacy Comments
Contract Details
Approval Date
10/1/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Pat Gerveler, Executive Vice President/Chief Financial Officer
(217) 223-8400 Ext: 6814
Contract Pharmacy Representative
Maxwell Pharmacy, Inc.
Matt Maxwell, PIC
(573) 822-5800
Signed By Date
10/1/2024
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