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HUDSON DRUG SHOP
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
HUDSON DRUG SHOP
Pharmacy Address
108 N MARKET ST
PO BOX 70
PAXTON, IL 60957-1220
Pharmacy Comments
Contract Details
Approval Date
1/11/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Dennis P. Hesch, Executive VP and CFO
(217) 326-8231
Contract Pharmacy Representative
Hudson Drug Shop
Andy Hudson, President
(217) 379-4858
Signed By Date
1/11/2016
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