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KIMMEL-CHAPLAIN PHARMACY
CAH141321-00 Franklin Hospital District
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Covered Entity Details
Entity Name
Franklin Hospital District
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141321-00
Entity Address
201 Bailey Lane
Benton, IL 62812-1999
Medicare Provider Number
141321
Participating Start Date
1/1/2013
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
KIMMEL-CHAPLAIN PHARMACY
Pharmacy Address
315 N MAIN ST
BENTON, IL 62812-1358
Pharmacy Comments
Contract Details
Approval Date
12/29/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rikki S. Bonthron, CFO
(618) 439-3161 Ext: 9601
Contract Pharmacy Representative
Julie Giacone, Registered Pharmacist
(618) 438-2822
Signed By Date
12/29/2016
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