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SCHNUCKS PHARMACY
DSH140091 The Carle Foundation Hospital
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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
Pharmacy Address
SCHNUCK MARKETS INC
109 NORTH MATTIS
CHAMPAIGN, IL 61821
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
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