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MCKNIGHT PHARMACY
CAH141304-00 Genesis Medical Center, Aledo
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Covered Entity Details
Entity Name
Genesis Medical Center, Aledo
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141304-00
Entity Address
409 NW 9TH AVE
ALEDO, IL 61231
Medicare Provider Number
141304
Participating Start Date
9/28/2010
Last Recertification Date
8/26/2024
Pharmacy Details
Pharmacy Name
MCKNIGHT PHARMACY
Pharmacy Address
109 SOUTH COLLEGE AVENUE
PO BOX 209
ALEDO, IL 61231
Pharmacy Comments
Contract Details
Approval Date
3/15/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/22/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Edward Rogalski, Administrator
(309) 582-3700
Contract Pharmacy Representative
David McKnight, Owner
(309) 582-2112
Signed By Date
1/29/2013
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