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GRAND PHARMACY
DSH140015 BLESSING HOSPITAL
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Covered Entity Details
Entity Name
BLESSING HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140015
Entity Address
1005 BROADWAY
QUINCY, IL 62301
Medicare Provider Number
140015
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
GRAND PHARMACY
Pharmacy Address
733 GRAND AVE.
HANNIBAL, MO 63401
Pharmacy Comments
Contract Details
Approval Date
1/27/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Pat Gerveler, Executive Vice President/Chief Financial Officer
(217) 223-8400 Ext: 6814
Contract Pharmacy Representative
Grand Pharmacy
Greg Gilmore, Owner
(573) 221-2792
Signed By Date
1/7/2025
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