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HIGHLAND PARK CVS, L.L.C.
DSH140137 HSHS Holy Family Hospital, Inc.
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Covered Entity Details
Entity Name
HSHS Holy Family Hospital, Inc.
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140137
Entity Address
200 Healthcare Drive
Greenville, IL 62246
Medicare Provider Number
140137
Participating Start Date
7/1/2012
Last Recertification Date
8/27/2021
Entity Termination Date
4/1/2022
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06930
401 E. HARRIS
GREENVILLE, IL 62246
Pharmacy Comments
Contract Details
Approval Date
7/15/2013
Contract Begin Date
10/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/13/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Brian Nall, CEO
(618) 664-1230 Ext: 8410
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
7/15/2013
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