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HIGHLAND PARK CVS, L.L.C.
CAH141327-00 Wabash General Hospital District
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Covered Entity Details
Entity Name
Wabash General Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141327-00
Entity Address
1418 College Drive
Mt Carmel, IL 62863
Medicare Provider Number
141327
Participating Start Date
10/1/2011
Last Recertification Date
8/19/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06887
915 N. MARKET ST.
MOUNT CARMEL, IL 62863
Pharmacy Comments
Contract Details
Approval Date
4/3/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen Douglas McGill, CFO
(618) 263-6305
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/3/2017
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