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THE PHARMACIE SHOPPE
CH053320 SIHF Healthcare
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Covered Entity Details
Entity Name
SIHF Healthcare
Subdivision Name
SIHF Healthcare
Type
HRSA-Funded Health Center
340B ID
CH053320
Entity Address
2041 Goose Lake Rd,
Sauget, IL 62206-2822
Grant Number
H80CS00195
Participating Start Date
7/1/2001
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
THE PHARMACIE SHOPPE
Pharmacy Address
MOORE FAMILY STORES
202 W EDGAR AVE
CASEY, IL 62420-1024
Pharmacy Comments
Contract Details
Approval Date
10/12/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Larry McCulley, President
(618) 332-0694 Ext: 155
Contract Pharmacy Representative
The Pharmacie Shoppe
Trent Moore, Owner
(217) 362-6226 Ext: 4
Signed By Date
10/12/2017
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