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PRINCETON PHARMACY
CAH141337-00 OSF Saint Clare Medical Center
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Covered Entity Details
Entity Name
OSF Saint Clare Medical Center
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH141337-00
Entity Address
530 Park Ave East
Princeton, IL 61356
Medicare Provider Number
141337
Participating Start Date
1/1/2013
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
PRINCETON PHARMACY
Pharmacy Address
610 N MAIN ST
PRINCETON PHARMACY
PRINCETON, IL 61356-1329
Pharmacy Comments
Contract Details
Approval Date
4/5/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2018
Agreement registered in error
Contacts
Covered Entity Signing Official
Annette Schnabel, President & CEO
(815) 876-2236
Contract Pharmacy Representative
Princeton Pharmacy
Lisa Stefani, Owner
(815) 875-1237
Signed By Date
4/5/2018
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