Contract Pharmacy Details

MEDEX PHARMACY INC
HV05332W SIHF Healthcare

Covered Entity Details

Entity Name

SIHF Healthcare

Subdivision Name

SIHF Healthcare - West Belleville

Type

Ryan White Part C

340B ID

HV05332W

Entity Address

7210 West Main St
Belleville, IL 62223

Grant Number

H76HA00579

Participating Start Date

10/1/2015

Last Recertification Date

2/22/2025

Pharmacy Details

Pharmacy Name

MEDEX PHARMACY INC

Pharmacy Address

1704 NORTH ILLINOIS
SWANSEA, IL 62226-3948

Pharmacy Comments

Contract Details

Approval Date

10/5/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/22/2019
Pharmacy closed

Contacts

Covered Entity Signing Official

Larry McCulley, President
(618) 332-0694 Ext: 155

Contract Pharmacy Representative

Richard Sprehe, Owner
(618) 236-1144

Signed By Date

10/5/2015