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MEDICENTER PHARMACY DUQUOIN
CAH141307-00 PINCKNEYVILLE COMMUNITY HOSPITAL
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Covered Entity Details
Entity Name
PINCKNEYVILLE COMMUNITY HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141307-00
Entity Address
5383 STATE ROUTE 154
PINCKNEYVILLE, IL 62274
Medicare Provider Number
141307
Participating Start Date
1/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
MEDICENTER PHARMACY DUQUOIN
Pharmacy Address
TOWN & COUNTRY PHARMACIES, INC.
204 S WASHINGTON ST.
DU QUOIN, IL 62832-1805
Pharmacy Comments
Contract Details
Approval Date
1/15/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KARA JO CARSON, CFO
(618) 357-2187 Ext: 5902
Contract Pharmacy Representative
Brad Galli, Owner
(618) 542-2575
Signed By Date
1/15/2015
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