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ACCREDO HEALTH GROUP, INC.
DSH140239 Javon Bea Hospital
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Covered Entity Details
Entity Name
Javon Bea Hospital
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140239
Entity Address
8201 E Riverside Blvd
Rockford, IL 61114
Medicare Provider Number
140239
Participating Start Date
1/1/2008
Last Recertification Date
8/30/2024
Pharmacy Details
Pharmacy Name
ACCREDO HEALTH GROUP, INC.
Pharmacy Address
2 BOULDEN CIR STE 1
NEW CASTLE, DE 19720-3492
Pharmacy Comments
Contract Details
Approval Date
7/10/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/27/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Henry Seybold, Senior Vice President / CFO
(815) 971-6796
Contract Pharmacy Representative
Accredo Health Group
Mark Leeper, Senior Director
(317) 240-8383
Signed By Date
7/10/2015
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