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MONTICELLO DRUGS
CAH141301-00 Kirby Medical Center
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Covered Entity Details
Entity Name
Kirby Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141301-00
Entity Address
1000 Medical Center Drive
Monticello, IL 61856
Medicare Provider Number
141301
Participating Start Date
4/1/2013
Last Recertification Date
8/20/2024
Pharmacy Details
Pharmacy Name
MONTICELLO DRUGS
Pharmacy Address
109 W MAIN STREET
MONTICELLO, IL 61856
Pharmacy Comments
Contract Details
Approval Date
3/15/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/27/2016
Pharmacy closed
Contacts
Covered Entity Signing Official
Steven D. Tenhouse, Chief Executive Officer
(217) 762-2115 Ext: 1501
Contract Pharmacy Representative
Martin R. Woodruff, President
(217) 762-2425
Signed By Date
3/15/2013
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