Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
RRC140046-00 GOOD SAMARITAN REGIONAL HEALTH CTR.

Covered Entity Details

Entity Name

GOOD SAMARITAN REGIONAL HEALTH CTR.

Subdivision Name

Type

Rural Referral Center

340B ID

RRC140046-00

Entity Address

1 GOOD SAMARITAN WAY
MT. VERNON, IL 62864

Medicare Provider Number

140046

Participating Start Date

10/1/2015

Last Recertification Date

9/14/2022

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06921
225 N. POPLAR ST.
CENTRALIA, IL 62801

Pharmacy Comments

Contract Details

Approval Date

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Eileen Lamm, Regional Vice President-Finance
(314) 994-6219

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/14/2025

340B Drug Pricing Program Database