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TOWN & COUNTRY PHARMACIES, INC.
CAH141338-00 Memorial Hospital
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Covered Entity Details
Entity Name
Memorial Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141338-00
Entity Address
1900 State Street
Chester, IL 62233
Medicare Provider Number
141338
Participating Start Date
4/1/2012
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
TOWN & COUNTRY PHARMACIES, INC.
Pharmacy Address
TONY'S MEDICENTER PHARMACY
324 W BROADWAY
STEELEVILLE, IL 62288
Pharmacy Comments
Contract Details
Approval Date
1/12/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/9/2019
Ownership change
Contacts
Covered Entity Signing Official
Brett Bollmann, Chief Executive Officer
(618) 826-4581 Ext: 1298
Contract Pharmacy Representative
EDS MEDICENTER PHARMACY
Steve Sommer, Manager Contracting & Channel Management
(618) 826-2511
Signed By Date
1/12/2016
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