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MEDICATE PHARMACY
CH05332U Southern Illinois Health Care Foundation, Inc.
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Covered Entity Details
Entity Name
Southern Illinois Health Care Foundation, Inc.
Subdivision Name
MADISON HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH05332U
Entity Address
304 Madison Ave
Madison, IL 62060-1110
Grant Number
H80CS00195
Participating Start Date
1/1/2008
Last Recertification Date
2/13/2017
Entity Termination Date
4/1/2017
Pharmacy Details
Pharmacy Name
MEDICATE PHARMACY
Pharmacy Address
100 N 8TH ST STE 100
EAST SAINT LOUIS, IL 62201-2989
Pharmacy Comments
Contract Details
Approval Date
6/21/2012
Contract Begin Date
6/21/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2017
Contacts
Covered Entity Signing Official
Larry McCulley, President
(618) 332-0694 Ext: 155
Contract Pharmacy Representative
Michael Schaltenbrand, Owner
(618) 709-7520
Signed By Date
6/6/2012
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