Contract Pharmacy Details

UNITYPOINT AT HOME
DSH140209 METHODIST MEDICAL CENTER OF ILLINOIS

Covered Entity Details

Entity Name

METHODIST MEDICAL CENTER OF ILLINOIS

Subdivision Name

Type

Disproportionate Share Hospital

340B ID

DSH140209

Entity Address

221 NE GLEN OAK AVE.
PEORIA, IL 61636

Medicare Provider Number

140209

Participating Start Date

10/1/2006

Last Recertification Date

9/3/2024

Pharmacy Details

Pharmacy Name

UNITYPOINT AT HOME

Pharmacy Address

11333 AURORA AVE
URBANDALE, IA 50322

Pharmacy Comments

Contract Details

Approval Date

4/16/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Keith E. Knepp, CEO
(309) 671-2528

Contract Pharmacy Representative

UnityPoint at Home
Ethan Middleton, Director Specialty Pharmacy
(515) 727-1160

Signed By Date

4/16/2018

340B Drug Pricing Program Database