Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
DSH140052 OSF SAINT ANTHONY'S HEALTH CENTER

Covered Entity Details

Entity Name

OSF SAINT ANTHONY'S HEALTH CENTER

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140052

Entity Address

1 SAINT ANTHONYS WAY
ALTON, IL 62002

Medicare Provider Number

140052

Participating Start Date

3/15/2022

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 06832
2422 COLLEGE AVE.
ALTON, IL 62002

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

7/5/2018
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Diane L. McGrew, President
(309) 655-2850

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

4/15/2016

340B Drug Pricing Program Database