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HIGHLAND PARK CVS, L.L.C.
SCH140064-00 ST. MARY MEDICAL CENTER
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Covered Entity Details
Entity Name
ST. MARY MEDICAL CENTER
Subdivision Name
Type
Sole Community Hospital
340B ID
SCH140064-00
Entity Address
3333 N SEMINARY
GALESBURG, IL 61401
Medicare Provider Number
140064
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16324
1071 W CARL SANDBURG DR
GALESBURG, IL 61401
Pharmacy Comments
Contract Details
Approval Date
4/2/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sandra Salverson, SVP Pharmacy Services
(309) 624-8817
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/2/2025
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