Contract Pharmacy Details

SCHNUCK MARKETS
RRC140034-00 ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS

Covered Entity Details

Entity Name

ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS

Subdivision Name

Type

Rural Referral Center

340B ID

RRC140034-00

Entity Address

400 NORTH PLEASANT AVENUE
CENTRALIA, IL 62801

Medicare Provider Number

140034

Participating Start Date

4/1/2011

Last Recertification Date

9/19/2022

Entity Termination Date

7/1/2023

Pharmacy Details

Pharmacy Name

SCHNUCK MARKETS

Pharmacy Address

D.B.A. SCHNUCKS PHARMACY #733
1129 W. BROADWAY
CENTRALIA, IL 62801

Pharmacy Comments

Contract Details

Approval Date

1/9/2017

Contract Begin Date

4/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/12/2021
Pharmacy closed

Contacts

Covered Entity Signing Official

John Sigsbury, PRESIDENT
(618) 436-6525

Contract Pharmacy Representative

Schnuck's Pharmacy
David Chism, Director of Pharmacy
(314) 344-9636

Signed By Date

1/9/2017

340B Drug Pricing Program Database