Contract Pharmacy Details

COMMCARE PHARMACY-FTL, LLC
CAH141335-00 Mercy Harvard Hospital, Inc

Covered Entity Details

Entity Name

Mercy Harvard Hospital, Inc

Subdivision Name

Type

Critical Access Hospital

340B ID

CAH141335-00

Entity Address

901 Grant Street
Harvard, IL 60033-1821

Medicare Provider Number

141335

Participating Start Date

1/1/2014

Last Recertification Date

8/29/2024

Pharmacy Details

Pharmacy Name

COMMCARE PHARMACY-FTL, LLC

Pharmacy Address

855 SW 78TH AVE STE C100
PLANTATION, FL 33324-3223

Pharmacy Comments

Contract Details

Approval Date

4/17/2017

Contract Begin Date

7/1/2017

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Shannon Dunphy-Alexander, Finance Director
(608) 757-3126

Contract Pharmacy Representative

Commcare Pharmacy
Avani Patel, Client Relations Manager
(954) 284-2358

Signed By Date

4/17/2017

340B Drug Pricing Program Database