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BLESSING HOSPITAL PHARMACY
CAH141315-00 Illini Community Hospital
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Covered Entity Details
Entity Name
Illini Community Hospital
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141315-00
Entity Address
640 W. Washington Street
Pittsfield, IL 62363
Medicare Provider Number
141315
Participating Start Date
1/1/2014
Last Recertification Date
8/12/2024
Pharmacy Details
Pharmacy Name
BLESSING HOSPITAL PHARMACY
Pharmacy Address
1005 BROADWAY ST
QUINCY, IL 62301
Pharmacy Comments
Contract Details
Approval Date
1/10/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/16/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Kathy Hull, President/CEO
(217) 285-2113 Ext: 3803
Contract Pharmacy Representative
Blessing Health System
Angela Byerly, Manager, Pharmacy
(217) 223-8400
Signed By Date
1/10/2018
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