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DOC'S DRUGS OF FAIRBURY
CAH141317-00 GIBSON COMMUNITY HOSPITAL DBA GIBSON AREA HOSPITAL AND HEALTH SERVICES
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Covered Entity Details
Entity Name
GIBSON COMMUNITY HOSPITAL DBA GIBSON AREA HOSPITAL AND HEALTH SERVICES
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141317-00
Entity Address
1120 N MELVIN
GIBSON CITY, IL 60936
Medicare Provider Number
141317
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
DOC'S DRUGS OF FAIRBURY
Pharmacy Address
902 E. OAK
FAIRBURY, IL 61739
Pharmacy Comments
Contract Details
Approval Date
7/3/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/3/2017
Ownership change
Contacts
Covered Entity Signing Official
JOHN JACOBSON, CFO
(217) 784-2601
Contract Pharmacy Representative
Anthony Sartoris, President
(815) 458-6401 Ext: 12
Signed By Date
7/3/2013
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