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METROPOLIS DRUGS II
CAH141323-00 MASSAC COUNTY HOSPITAL DISTRICT
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Covered Entity Details
Entity Name
MASSAC COUNTY HOSPITAL DISTRICT
Subdivision Name
Massac Memorial Hospital
Type
Critical Access Hospital
340B ID
CAH141323-00
Entity Address
28 CHICK ST.
METROPOLIS, IL 62960
Medicare Provider Number
141323
Participating Start Date
8/31/2010
Last Recertification Date
9/6/2024
Pharmacy Details
Pharmacy Name
METROPOLIS DRUGS II
Pharmacy Address
LAWSON, LESLIE JO
1201 W 10TH ST
METROPOLIS, IL 62960-2433
Pharmacy Comments
Contract Details
Approval Date
10/12/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Randall Rushing, Chief Financial Officer
(618) 524-2176 Ext: 257
Contract Pharmacy Representative
Metropolis Drugs II
Tim Lawson, Owner
(618) 524-8400
Signed By Date
10/12/2016
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