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HIGHLAND PARK CVS, L.L.C.
CHC24098-20 SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
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Covered Entity Details
Entity Name
SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Subdivision Name
SIU Medicine North Dirksen Express Care
Type
HRSA-Funded Health Center
340B ID
CHC24098-20
Entity Address
3220 Atlanta St
Springfield, IL 62707-8801
Grant Number
H80CS24098
Participating Start Date
10/1/2024
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06932
608 S. MAIN ST.
HILLSBORO, IL 62049
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Iris Elenora Wesley, CEO
(217) 757-8116
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/15/2025
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