Contract Pharmacy Details

SCHNUCKS PHARMACY #730
DSH140091 The Carle Foundation Hospital

Covered Entity Details

Entity Name

The Carle Foundation Hospital

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140091

Entity Address

611 West Park Street
Urbana, IL 61801

Medicare Provider Number

140091

Participating Start Date

10/1/2012

Last Recertification Date

9/4/2024

Pharmacy Details

Pharmacy Name

SCHNUCKS PHARMACY #730

Pharmacy Address

1301 SAVOY PLAZA CENTER
SAVOY, IL 61874

Pharmacy Comments

Contract Details

Approval Date

10/14/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/16/2020
Ownership change

Contacts

Covered Entity Signing Official

Dennis P. Hesch, Executive VP and CFO
(217) 326-8231

Contract Pharmacy Representative

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

Signed By Date

10/14/2013

340B Drug Pricing Program Database