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STUTS DRUG STORE INC
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
STUTS DRUG STORE INC
Pharmacy Address
RELANDER DAVID, PRESIDENT
105 S. COLLEGE AVENUE
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
4/14/2017
Pharmacy closed
Contacts
Covered Entity Signing Official
Edward Rogalski, Administrator
(309) 582-3700
Contract Pharmacy Representative
David Relander, Owner
(309) 582-5151
Signed By Date
1/29/2013
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