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MEDICENTER PHARMACY DUQUOIN
CH05213L CHRISTOPHER RURAL HEALTH PLANNING CORP
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Covered Entity Details
Entity Name
CHRISTOPHER RURAL HEALTH PLANNING CORP
Subdivision Name
REA CLINIC-DUQUOIN FACILITY
Type
HRSA-Funded Health Center
340B ID
CH05213L
Entity Address
119 Gas Plant Rd
Du Quoin, IL 62832-3866
Grant Number
H80CS00726
Participating Start Date
10/1/1998
Last Recertification Date
2/28/2018
Entity Termination Date
4/1/2019
Pharmacy Details
Pharmacy Name
MEDICENTER PHARMACY DUQUOIN
Pharmacy Address
TOWN & COUNTRY PHARMACIES, INC.
204 S WASHINGTON ST.
DU QUOIN, IL 62832-1805
Pharmacy Comments
Contract Details
Approval Date
4/16/2010
Contract Begin Date
4/16/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
KIMBERLY A. MITROKA, PRESIDENT/CEO
(618) 724-2436 Ext: 1602
Contract Pharmacy Representative
BRAD GALLI, OWNER
(618) 542-2575
Signed By Date
4/6/2010
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