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HIGHLAND PARK CVS, L.L.C.
DSH260032 BARNES-JEWISH HOSPITAL
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Covered Entity Details
Entity Name
BARNES-JEWISH HOSPITAL
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH260032
Entity Address
One Barnes-Jewish Hospital Plaza
St. Louis, MO 63110
Medicare Provider Number
260032
Participating Start Date
7/1/2004
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06830
4609 W. MAIN ST.
BELLEVILLE, IL 62226
Pharmacy Comments
Contract Details
Approval Date
7/17/2015
Contract Begin Date
10/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/15/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Cannon, President
(314) 286-2118
Contract Pharmacy Representative
CVS
Christian Reid, 340B Program Director, CVS Pharmacy
(401) 770-2118
Signed By Date
7/17/2015
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