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MEIJER DISTRIBUTION INC #90
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
MEIJER DISTRIBUTION INC #90
Pharmacy Address
2721 WALKER AVE NW
GRAND RAPIDS, MI 49544
Pharmacy Comments
Distribution Center
Contract Details
Approval Date
10/7/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dennis P. Hesch, Executive VP and CFO
(217) 326-8231
Contract Pharmacy Representative
Meijer
Jeff Romano, Hospital Programs
(616) 791-3171
Signed By Date
10/7/2014
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