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THE PHARMACY STOP MEDICAL CENTER
RRC140110-00 OTTAWA REGIONAL HOSPITAL & HEALTHCAR
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Covered Entity Details
Entity Name
OTTAWA REGIONAL HOSPITAL & HEALTHCAR
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140110-00
Entity Address
1100 EAST NORRIS DRIVE
OTTAWA, IL 61350
Medicare Provider Number
140110
Participating Start Date
7/1/2015
Last Recertification Date
9/5/2019
Entity Termination Date
7/1/2020
Pharmacy Details
Pharmacy Name
THE PHARMACY STOP MEDICAL CENTER
Pharmacy Address
BENNER FAMILY PHARMACY INC
1614 E. NORRIS DRIVE
OTTAWA, IL 61350
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/14/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Diane L. McGrew, President
(309) 655-2850
Contract Pharmacy Representative
John Groesbeck, President
(815) 257-3622
Signed By Date
4/15/2016
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