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MEDICATE PHARMACY
HV05332W SIHF Healthcare
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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
MEDICATE PHARMACY
Pharmacy Address
2166 MADISON AVE
GRANITE CITY, IL 62040
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
10/12/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Larry McCulley, President
(618) 332-0694 Ext: 155
Contract Pharmacy Representative
Michael Schaltenbrand, Owner
(618) 709-7520
Signed By Date
10/5/2015
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