Covered Entity Details

CH05642AC LAWNDALE CHRISTIAN HEALTH CENTER (Terminated) - information as of 5/1/2025 11:48:03 PM

Main Details

Name

LAWNDALE CHRISTIAN HEALTH CENTER

Subdivision Name

Temporary Site - North Park Village Apartments

Type

HRSA-Funded Health Center

Site ID

BPS-H80-036739

340B ID

CH05642AC

Grant Number

H80CS00725

Additional Details

Current Program Status

Terminated

Registration Date

1/9/2024

Participating Start Date

4/1/2024

Participating Approval Date

1/10/2024

Last Recertification Date

Termination Date
Termination Reason

10/1/2024
Site closure

Contacts

Authorizing Official

Lawndale Christian Health Center
Christopher Robert Dons, Chief Financial Officer
(872) 588-3032

Primary Contact

Lawndale Christian Health Center
Alexandra Cueto, Internal Auditor
(872) 588-3027

Addresses

Street Address

5801 N Pulaski Road BLDG H
Chicago, IL 60646

Billing Address

LAWNDALE CHRISTIAN HLTH CTR
3860 WEST OGDEN AVENUE
CHICAGO, IL 60623

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
Yes

State	Medicaid Number	NPI Number
IL	363308953001	1245289214

Shipping Addresses

Shipping Address 1

LAWNDALE CHRISTIAN HLTH CTR
3860 WEST OGDEN AVENUE
CHICAGO, IL 60623

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
No records to display.

Grantee Sites

340B ID	340B Status	SiteId	Name	Sub Name	Address	City	State
CH056420	Active	BPS-H80-004134	LAWNDALE CHRISTIAN HEALTH CENTER	Lawndale Christian Health Center Main Clinic	3860 W Ogden Ave	Chicago	IL
CH05642A	Active	BPS-H80-008315	LAWNDALE CHRISTIAN HLTH CTR	LCHC at Archer Avenue	5122 S Archer Ave	CHICAGO	IL
CH05642AA	Terminated	BPS-H80-037156	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - Gage Park	2411 W 55th St	Chicago	IL
CH05642AB	Terminated	BPS-H80-037720	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - Halsted Shelter	2241 S Halsted Street	Chicago	IL
CH05642AC	Terminated	BPS-H80-036739	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - North Park Village Apartments	5801 N Pulaski Road BLDG H	Chicago	IL
CH05642AD	Active	BPS-H80-032530	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Primo Center for Women and Children	4952 W Madison St	Chicago	IL
CH05642AE	Terminated	BPS-H80-037721	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - Walnut Shelter	1644 W. Walnut Street	Chicago	IL
CH05642AF	Terminated	BPS-H80-036738	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - Inn of Chicago	162 E Ohio St	Chicago	IL
CH05642AG	Active	BPS-H80-036821	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Bobby E. Wright	5002 W Madison St	Chicago	IL
CH05642AH	Terminated	BPS-H80-037576	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - Piotrowski Park	4247 W 31st St	Chicago	IL
CH05642AJ	Terminated	BPS-H80-037719	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - Ogden Shelter	344 N Ogden Avenue	Chicago	IL
CH05642AK	Terminated	BPS-H80-038363	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - New Life Little Village	2634 S Pulaski Rd	Chicago	IL
CH05642AL	Terminated	BPS-H80-038201	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - West Lake	939 W Lake St	Chicago	IL
CH05642AM	Active	BPS-H80-038189	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - Young Women's Leadership Academy	2641 S Calumet Ave	Chicago	IL
CH05642AN	Terminated	BPS-H80-038508	LAWNDALE CHRISTIAN HEALTH CENTER	Temporary Site - Lawndale Christian Health	526 N Western Ave RM 1	Chicago	IL
CH05642B	Active	BPS-H80-003389	LAWNDALE CHRISTIAN HLTH CTR	LCHC at Homan Square	3517 W Arthington St Side West	CHICAGO	IL
CH05642C	Active	BPS-H80-001032	LAWNDALE CHRISTIAN HLTH CTR	LCHC at Farragut Academy	3256 W 24th St	Chicago	IL
CH05642D	Active	BPS-H80-015264	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Habilitative Systems	415 S Kilpatrick Ave	Chicago	IL
CH05642E	Active	BPS-H80-015259	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Walls Memorial	200 S Sacramento Blvd	CHICAGO	IL
CH05642F	Terminated	BPS-H80-015256	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Bobby E. Wright	9 Kedzie Ave	Chicago	IL
CH05642G	Active	BPS-H80-015255	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Hand-n-Hand	4207 W. Carroll Ave	Chicago	IL
CH05642H	Terminated	BPS-H80-015774	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Primo	1609 S Homan Ave	Chicago	IL
CH05642J	Active	BPS-H80-015423	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Breakthrough Men's Shelter	402 N Saint Louis Ave	CHICAGO	IL
CH05642K	Terminated	BPS-H80-015265	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Franciscan Outreach	10 S. Kedzie	Chicago	IL
CH05642L	Active	BPS-H80-015169	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Breakthrough Women's Center	3330 W. Carroll Ave	Chicago	IL
CH05642M	Terminated	BPS-H80-015152	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Breaking Bread	1111 N. Wells	Chicago	IL
CH05642N	Active	BPS-H80-008113	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC Health & Fitness - 3750	3750 W Ogden Ave	Chicago	IL
CH05642P	Active	BPS-H80-002832	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC Eye Clinic	3851 W Ogden Ave	CHICAGO	IL
CH05642Q	Active	BPS-H80-014538	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Garfield Park FamilyPlex	3219 W Carroll Ave Fl 1	CHICAGO	IL
CH05642R	Terminated	BPS-H80-020827	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at San Jose Obrero	1856 S Loomis St	Chicago	IL
CH05642S	Terminated	BPS-H80-002318	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC Belle Whaley	3812 W. Ogden Ave	CHICAGO	IL
CH05642T	Active	BPS-H80-019175	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at 3910	3910 W Ogden Ave	Chicago	IL
CH05642U	Active	BPS-H80-020774	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Neopolitan Lighthouse	3860 West Ogden Ave	Chicago	IL
CH05642V	Active	BPS-H80-027462	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Pacific Garden Mission	1458 S Canal St FL 1, EX #2	Chicago	IL
CH05642W	Active	BPS-H80-029696	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Salvation Army Freedom Center	825 N Christiana Ave Rm 042	Chicago	IL
CH05642X	Active	BPS-H80-030055	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at the Gallery	3824 W Ogden Ave Fl 1	Chicago	IL
CH05642Y	Active	BPS-H80-030177	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at 3745	3745 W Ogden Ave	Chicago	IL
CH05642Z	Active	BPS-H80-032476	LAWNDALE CHRISTIAN HEALTH CENTER	LCHC at Franciscan Harrison	2715 W Harrison St	Chicago	IL

Grantee Sites Contract Pharmacies

340B ID	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Begin Date	Termination Date
CH056420	AMERICAN DRUG STORES LLC	DBA OSCO DRUG 3170	5324 S. PULASKI	CHICAGO	IL	60632	07/01/2022	11/21/2024
CH056420	BIOPLUS SPECIALTY PHARMACY SERVICES, LLC	376 NORTHLAKE BLVD		ALTAMONTE SPRINGS	FL	32701-5261	07/01/2019	03/19/2024
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03395	3401 W ROOSEVELT RD	CHICAGO	IL	60624	11/07/2011	11/12/2024
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02903	5222 WEST MADISON ST	CHICAGO	IL	60644	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05103	5932 W. CERMAK RD	CICERO	IL	60804	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04938	4748 W NORTH AVE	CHICAGO	IL	60639	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05234	5435 S KEDZIE AVE	CHICAGO	IL	60632	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 01417	1931 W CERMAK RD	CHICAGO	IL	60608	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05034	6315 S KEDZIE AVE	CHICAGO	IL	60629	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05076	6800 OGDEN AVE	BERWYN	IL	60402	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03961	2340 W MADISON ST	CHICAGO	IL	60612	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04147	1546 N. CENTRAL AVE.	CHICAGO	IL	60651-1259	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05356	4710 S WESTERN AVE	CHICAGO	IL	60609	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 11410	1627 N PULASKI RD	CHICAGO	IL	60639	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS #11492	5414 S. ARCHER AVE	CHICAGO	IL	60638-3002	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02785	5840 WEST 35TH ST	CICERO	IL	60804	11/07/2011
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03779	100 LAKE ST	MAYWOOD	IL	60153	10/01/2014
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04233	5600 W. FULLERTON	CHICAGO	IL	60639	01/01/2016
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04986	4745 W BELMONT AVE	CHICAGO	IL	60641-4410	01/01/2016
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05089	7111 S WESTERN AVE	CHICAGO	IL	60636	01/01/2016	02/17/2025
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05235	6412 ROOSEVELT RD	OAK PARK	IL	60304-2135	01/01/2016
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS #11760	811 MADISON ST	OAK PARK	IL	60302	01/01/2016
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05149	1600 W. ROOSEVELT RD	BROADVIEW	IL	60155	07/01/2016
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02711	7150 W ARCHER AVE	CHICAGO	IL	60638	10/01/2017
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 01310	3110 W ARMITAGE	CHICAGO	IL	60647	01/01/2018
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04978	111 S. HALSTED STREET	CHICAGO	IL	60661	07/01/2018
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 01503	1926 W 35TH ST	CHICAGO	IL	60609	04/01/2019
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05123	10300 S. MICHIGAN AVE.	CHICAGO	IL	60628	04/01/2019
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04306	1633 W. 95TH STREET	CHICAGO	IL	60643	04/01/2019
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04461	501 W ROOSEVELT RD	CHICAGO	IL	60607	04/01/2020
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA WALGREENS SPECIALTY PHARMACY #04505	4025 N. SHERIDAN RD.	CHICAGO	IL	60613	04/01/2020	10/18/2024
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	WALGREENS # 16525	5401 S WENTWORTH AVE SUITE 5A1	CHICAGO	IL	60609	04/01/2020
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02877	2440 W NORTH AVE	CHICAGO	IL	60647	04/01/2021
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS #15080	5555 WEST 79TH ST	BURBANK	IL	60459	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03960	7200 ROOSEVELT RD	FOREST PARK	IL	60130	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05139	7945 W 95TH ST	HICKORY HILLS	IL	60457	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05033	2015 E 79TH ST	CHICAGO	IL	60649	01/01/2022	11/06/2024
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03074	4700 S. HALSTED ST	CHICAGO	IL	60609	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05055	12290 S PULASKI RD	ALSIP	IL	60803	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04936	4040 N. CICERO AVE.	CHICAGO	IL	60641	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03833	2828 N HARLEM	ELMWOOD PARK	IL	60707	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02025	3000 S HALSTED	CHICAGO	IL	60608	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03076	7251 LAKE STREET	RIVER FOREST	IL	60305	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04862	4343 N CENTRAL AVE	CHICAGO	IL	60634	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04542	5625 N. RIDGE AVE	CHICAGO	IL	60660-3434	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 01308	7410 N CLARK	CHICAGO	IL	60626	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04009	4730 BUTTERFIELD ROAD	HILLSIDE	IL	60162	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04519	1320 E 47TH ST.	CHICAGO	IL	60653	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04935	6809 W BELMONT AVE	CHICAGO	IL	60634	01/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS #07360	3220 W. 111TH ST	CHICAGO	IL	60655	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS #13454	6140 N WESTERN AVE	CHICAGO	IL	60659	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05057	3153 W IRVING PARK RD	CHICAGO	IL	60618	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04664	10345 W ROOSEVELT ROAD	WESTCHESTER	IL	60154	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 01593	5230 N MILWAUKEE AVE	CHICAGO	IL	60630	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02840	1500 W WILSON AVE	CHICAGO	IL	60640	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04252	10 E ST CHARLES RD	VILLA PARK	IL	60181	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03995	6 E NORTH AVE	NORTHLAKE	IL	60164	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS #15364	635 CHICAGO AVENUE	EVANSTON	IL	60202	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04752	316 W. CERMAK ROAD	CHICAGO	IL	60616	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05193	3145 W 147TH ST	POSEN	IL	60469	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 11109	4800 148TH STREET	MIDLOTHIAN	IL	60445-3117	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04826	9800 IRVING PARK ROAD	SCHILLER PARK	IL	60176	04/01/2022	10/18/2024
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS #15635	3959 W. 95TH ST.	EVERGREEN PARK	IL	60805	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 01504	10639 S CICERO	OAK LAWN	IL	60453	04/01/2022
CH056420	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02211	5036 S COTTAGE GROVE AVE	CHICAGO	IL	60615	04/01/2022
CH05642T	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04306	1633 W. 95TH STREET	CHICAGO	IL	60643	10/01/2024	12/31/2024
CH05642A	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03395	3401 W ROOSEVELT RD	CHICAGO	IL	60624	10/01/2024	11/12/2024
CH05642Q	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05034	6315 S KEDZIE AVE	CHICAGO	IL	60629	10/01/2024	12/31/2024
CH05642B	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 02903	5222 WEST MADISON ST	CHICAGO	IL	60644	10/01/2024	12/31/2024
CH05642W	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 03961	2340 W MADISON ST	CHICAGO	IL	60612	10/01/2024	12/31/2024
CH05642E	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05234	5435 S KEDZIE AVE	CHICAGO	IL	60632	10/01/2024	12/31/2024
CH05642AA	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04938	4748 W NORTH AVE	CHICAGO	IL	60639	10/01/2024	10/01/2024
CH05642AF	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04147	1546 N. CENTRAL AVE.	CHICAGO	IL	60651-1259	10/01/2024	01/01/2025
CH05642AK	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 05076	6800 OGDEN AVE	BERWYN	IL	60402	10/01/2024	01/01/2025
CH05642AE	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04461	501 W ROOSEVELT RD	CHICAGO	IL	60607	10/01/2024	01/01/2025
CH05642AL	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 11410	1627 N PULASKI RD	CHICAGO	IL	60639	10/01/2024	04/01/2025
CH05642AM	BOND DRUG COMPANY OF ILLINOIS, L.L.C.	DBA: WALGREENS # 04938	4748 W NORTH AVE	CHICAGO	IL	60639	10/01/2024	12/31/2024
CH056420	BOND DRUG COMPANY OF ILLINOIS, LLC	DBA: WALGREENS #16000	6001 W 95TH ST	OAK LAWN	IL	60453	01/01/2022
CH056420	CAREMARK ILLINOIS SPECIALTY PHARMACY, LL	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	800 BIERMANN CT STE B	MOUNT PROSPECT	IL	60056	04/01/2020
CH056420	CVS CAREMARK	DBA CVS/CAREMARK OR CF# 11506	1 GREAT VALLEY BOULEVARD	WILKES BARRE	PA	18706	10/01/2021
CH056420	CVS CAREMARK ADVANCED TECHNOLOGY PHARMAC	DBA CVS/CAREMARK 48067	1780 WALL ST	MT PROSPECT	IL	60056	10/01/2021
CH056420	CYSTIC FIBROSIS SERVICES, LLC	DBA WALGREENS SPECIALTY PHARMACY #16280	10530 JOHN W ELLIOTT DR STE 200	FRISCO	TX	75033	01/01/2019
CH056420	DELIVERCARERX PHARMACY LLC	DELIVERCARERX PHARMACY LLC	1471 E BUSINESS CENTER DR STE 200	MT PROSPECT	IL	60056	04/01/2016	07/06/2023
CH056420	DIPLOMAT SPECIALTY PHARMACY	4100 S SAGINAW ST	STE D	FLINT	MI	48507-2683	10/01/2019	09/30/2020
CH056420	DOGWOOD PHARMACY, INC	D/B/A MEDSCRIPTS MEDICAL PHARMACY	1325 MILLER ROAD SUITE K	GREENVILLE	SC	29607-6540	07/01/2019	03/19/2024
CH056420	EXACT CARE PHARMACY	DDCRX, LLC	2701 HIGHPOINT OAKS DR STE 100	LEWISVILLE	TX	75067-3896	01/01/2023	08/22/2024
CH056420	EXACT CARE PHARMACY, LLC	8333 ROCKSIDE RD		CLEVELAND	OH	44125	01/01/2023	08/22/2024
CH056420	GENOA HEALTHCARE LLC	1400 W GREENLEAF AVE STE 101		CHICAGO	IL	60626	07/01/2022
CH056420	GENOA HEALTHCARE LLC	5710 N. BROADWAY STREET, SUITE P		CHICAGO	IL	60660-4302	07/01/2022
CH056420	GENOA HEALTHCARE LLC	2704 N MAIN ST RM A104		ROCKFORD	IL	61103-3112	07/01/2022
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 03163	345 MADISON ST.	OAK PARK	IL	60302	07/01/2019
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08502	6315 S PULASKI RD STE 1	CHICAGO	IL	60629	07/01/2019
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08741	2634 S PULASKI	CHICAGO	IL	60623	07/01/2019	06/07/2022
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01054	101 N. CLINTON ST.	CHICAGO	IL	60661	04/01/2020	07/14/2022
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY # 1965	7200 W. CERMAK RD.	NORTH RIVERSIDE	IL	60546	04/01/2020	02/27/2024
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 03889	7929 NORTH AVE.	RIVER FOREST	IL	60305	04/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04793	1211 W. ROOSEVELT RD.	CHICAGO	IL	60608	04/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05836	1228 E. 53RD ST.	CHICAGO	IL	60615	04/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08736	7216 CIRCLE AVE	FOREST PARK	IL	60130	04/01/2020	08/13/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08740	2427 W CHICAGO AVE	CHICAGO	IL	60622	04/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08742	5524 W CERMAK RD, STE 1	CICERO	IL	60804	04/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08910	205 N COLUMBUS DR	CHICAGO	IL	60601	04/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17042	6525 W DIVERSEY AVE	CHICAGO	IL	60707	04/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02664	11 E 14TH ST.,	CHICAGO HEIGHTS	IL	60411	07/01/2020	12/15/2022
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02827	600 NORTH MANNHEIM RD.	HILLSIDE	IL	60162	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02844	6748 ROOSEVELT RD.	OAK PARK	IL	60304	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02845	1930 W. 103RD ST.	CHICAGO	IL	60643	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02935	8712 SOUTH STONY ISLAND AVE.	CHICAGO	IL	60617	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02981	1201 N. STATE ST.	CHICAGO	IL	60610	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04061	520 S. STATE STREET	CHICAGO	IL	60605	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04487	8625 S. HARLEM AVE.	BRIDGEVIEW	IL	60455	07/01/2020	06/29/2022
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04979	7855 S. WESTERN AVE.	CHICAGO	IL	60620	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05681	3311 N. PULASKI RD.	CHICAGO	IL	60641	07/01/2020	11/05/2024
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05769	470 S. TORRENCE AVE.	CALUMET CITY	IL	60409	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06748	6210 MAIN ST.	DOWNERS GROVE	IL	60516	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07168	1725 WEST BOUGHTON RD.	BOLINGBROOK	IL	60490	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08738	741 W 31ST	CHICAGO	IL	60616	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08744	9139 BROADWAY	BROOKFIELD	IL	60513	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08745	771 N OGDEN AVE	CHICAGO	IL	60642	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16285	7100 S CICERO AVE	CHICAGO	IL	60629	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16999	4433 S PULASKI RD	CHICAGO	IL	60632	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17166	1940 W 33RD ST	CHICAGO	IL	60608	07/01/2020
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08735	3940 WEST FULLERTON	CHICAGO	IL	60647	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08519	11055 S. WESTERN AVENUE	CHICAGO	IL	60643	04/01/2021	02/21/2022
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08699	137 S STATE ST	CHICAGO	IL	60603	04/01/2021	01/02/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08505	6748 W 111TH ST	WORTH	IL	60482	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17536	130 S MANNHEIM RD	HILLSIDE	IL	60162	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08949	15840 S. CICERO AVE.	OAK FOREST	IL	60452	04/01/2021	09/13/2023
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01768	3400 LINCOLN HWY.	OLYMPIA FIELDS	IL	60461	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY # 2375	1022 W LINCOLN HWY.	DEKALB	IL	60115	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02790	3201 WEST 95TH ST.	EVERGREEN PARK	IL	60805	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02798	3951 W. 103RD ST.	CHICAGO	IL	60655	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02846	8639 S. CICERO AVE.	CHICAGO	IL	60652	04/01/2021	01/17/2024
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05001	3033 N. BROADWAY ST.	CHICAGO	IL	60657	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05421	2375 DRAUDEN RD	PLAINFIELD	IL	60586	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05987	4800 NORTH DAMEN	CHICAGO	IL	60625	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06785	3343 W. MONTROSE AVE.	CHICAGO	IL	60618	04/01/2021	06/05/2023
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 08695	3101 N. CLARK	CHICAGO	IL	60657	04/01/2021	11/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 17009	1154 S CLARK ST	CHICAGO	IL	60605	04/01/2021
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06789	8645 WOODWARD AVE.	WOODRIDGE	IL	60517	01/01/2022
CH056420	HIGHLAND PARK CVS, L.L.C.	CVS PHARMACY # 16219	2901 S CICERO AVE	CICERO	IL	60804	10/01/2022
CH056420	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01493	5205 N. BROADWAY ST.	CHICAGO	IL	60640	10/01/2022
CH05642AG	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 01493	5205 N. BROADWAY ST.	CHICAGO	IL	60640	10/01/2024
CH05642L	HIGHLAND PARK CVS, L.L.C.	DBA CVS/PHARMACY # 2375	1022 W LINCOLN HWY.	DEKALB	IL	60115	10/01/2024
CH05642U	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02798	3951 W. 103RD ST.	CHICAGO	IL	60655	10/01/2024
CH05642V	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02790	3201 WEST 95TH ST.	EVERGREEN PARK	IL	60805	10/01/2024
CH05642AD	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02827	600 NORTH MANNHEIM RD.	HILLSIDE	IL	60162	10/01/2024
CH05642S	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02844	6748 ROOSEVELT RD.	OAK PARK	IL	60304	10/01/2024	01/01/2025
CH05642P	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02845	1930 W. 103RD ST.	CHICAGO	IL	60643	10/01/2024
CH05642N	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 02935	8712 SOUTH STONY ISLAND AVE.	CHICAGO	IL	60617	10/01/2024
CH05642C	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04061	520 S. STATE STREET	CHICAGO	IL	60605	01/01/2025
CH05642J	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 03889	7929 NORTH AVE.	RIVER FOREST	IL	60305	01/01/2025
CH05642A	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 03163	345 MADISON ST.	OAK PARK	IL	60302	01/01/2025
CH05642AN	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04793	1211 W. ROOSEVELT RD.	CHICAGO	IL	60608	01/01/2025	01/01/2025
CH05642Y	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 07168	1725 WEST BOUGHTON RD.	BOLINGBROOK	IL	60490	04/01/2025	04/14/2025
CH05642Q	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04793	1211 W. ROOSEVELT RD.	CHICAGO	IL	60608	04/01/2025
CH05642X	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05769	470 S. TORRENCE AVE.	CALUMET CITY	IL	60409	04/01/2025
CH05642E	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05836	1228 E. 53RD ST.	CHICAGO	IL	60615	04/01/2025
CH05642B	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05421	2375 DRAUDEN RD	PLAINFIELD	IL	60586	04/01/2025
CH05642G	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05001	3033 N. BROADWAY ST.	CHICAGO	IL	60657	04/01/2025
CH05642W	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05681	3311 N. PULASKI RD.	CHICAGO	IL	60641	04/01/2025	01/01/2025
CH05642T	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06789	8645 WOODWARD AVE.	WOODRIDGE	IL	60517	04/01/2025	04/14/2025
CH05642D	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 04979	7855 S. WESTERN AVE.	CHICAGO	IL	60620	04/01/2025
CH05642Z	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 06748	6210 MAIN ST.	DOWNERS GROVE	IL	60516	04/01/2025
CH05642Y	HIGHLAND PARK CVS, L.L.C.	DBA: CVS/PHARMACY # 05987	4800 NORTH DAMEN	CHICAGO	IL	60625	04/01/2025
CH056420	OPTUM PHARMACY 702, LLC	1050 PATROL RD		JEFFERSONVILLE	IN	47130	07/01/2022
CH056420	OPTUM PHARMACY 801, INC.	24416 N 19TH AVE	STE. 100	PHOENIX	AZ	85085	07/01/2022
CH056420	PRIME THERAPEUTICS SPECIALTY PHARMACY LL	ALLIANCERX WALGREENS PRIME #16568	2354 COMMERCE PARK DRIVE SUITE 100	ORLANDO	FL	32819-9992	01/01/2019	10/01/2022
CH056420	PROCARE PHARMACY DIRECT, L.L.C.	DBA CVS/SPECIALTY OR CARELONRX SPECIALTY	105 MALL BOULEVARD	MONROEVILLE	PA	15146	04/01/2020
CH056420	RAINA RX LLC	DBA ROUTE 300 PHARMACY	1208 ROUTE 300 SUITE 103	NEWBURGH	NY	12550	07/01/2019	03/19/2024
CH056420	RIVER MEDICAL PHARMACY LLC	4752 RESEARCH DR		SAN ANTONIO	TX	78240-5002	07/01/2019	03/19/2024
CH056420	WAL-MART CENTRAL FILL 10-2670	608 SPRING HILL DR # 3 SUITE 300		SPRING	TX	77386	07/01/2019
CH056420	WAL-MART PHARMACY 10-5646	2551 W CERMAK		CHICAGO	IL	60608	07/01/2019	06/15/2023
CH056420	WAL-MART PHARMACY 10-5997	9600 PARKSOUTH CT. SUITE 100		ORLANDO	FL	32837	07/01/2019
CH056420	WALGREEN CO		DBA WALGREENS 4400 STATE RD 19	WINDSOR	WI	53598	02/02/2012	07/09/2015
CH056420	WALGREEN CO	DBA: WALGREENS #15525	201 E. HURON STREET, SUITE 01-210	CHICAGO	IL	60611	07/01/2017
CH056420	WALGREEN CO	WALGREENS #10558	250 S WACKER DR LBBY 1	CHICAGO	IL	60606	04/01/2022	11/07/2022
CH056420	Walgreen CO	DBA Walgreens Central Fill #21417	599 S Schmidt Rd Ste A	Bolingbrook	IL	60440-9405	04/01/2023
CH056420	WALGREEN CO.	DBA: WALGREENS # 01249	4800 W CERMAK RD	CICERO	IL	60804	11/07/2011	11/06/2024
CH056420	WALGREEN CO.	DBA: WALGREENS # 00226	4005 W 26TH STREET	CHICAGO	IL	60623	11/07/2011	02/18/2025
CH056420	WALGREEN CO.	DBA: WALGREENS # 00215	3045 W 26TH STREET	CHICAGO	IL	60623	11/07/2011
CH056420	WALGREEN CO.	DBA: WALGREENS # 05724	7045 S PULASKI ROAD	CHICAGO	IL	60629-5833	11/07/2011
CH056420	WALGREEN CO.	DBA: WALGREENS # 05926	4385 S ARCHER AVE	CHICAGO	IL	60632	11/07/2011
CH056420	WALGREEN CO.	DBA: WALGREENS # 05867	3943 W 47TH STREET	CHICAGO	IL	60632-4145	11/07/2011
CH056420	WALGREEN CO.	DBA: WALGREENS # 00163	4000 W 59TH ST	CHICAGO	IL	60629	11/07/2011
CH056420	WALGREEN CO.	DBA: WALGREENS # 05868	3798 SOUTH WESTERN AVE	CHICAGO	IL	60609-1014	10/01/2014	11/17/2015
CH056420	WALGREEN CO.	DBA: WALGREENS # 06297	6016 W 63RD STREET	CHICAGO	IL	60638-4318	10/01/2014
CH056420	WALGREEN CO.	DBA: WALGREENS # 06641	1614 W 47TH STREET	CHICAGO	IL	60609-3245	10/01/2014
CH056420	WALGREEN CO.	DBA: WALGREENS # 11154	7113 CERMAK RD	BERWYN	IL	60402	10/01/2014
CH056420	WALGREEN CO.	DBA: WALGREENS # 00232	3405 S KING DR	CHICAGO	IL	60616	01/01/2016	02/26/2025
CH056420	WALGREEN CO.	DBA: WALGREENS # 03321	5874 S ARCHER AVENUE	CHICAGO	IL	60638-1645	01/01/2016
CH056420	WALGREEN CO.	DBA: WALGREENS #15507	3800 W MADISON STREET SUITE 101	CHICAGO	IL	60624	01/01/2016
CH056420	WALGREEN CO.	DBA: WALGREENS # 09357	833 W 115TH ST	CHICAGO	IL	60643-4619	07/01/2016	11/09/2023
CH056420	WALGREEN CO.	DBA: WALGREENS # 10350	7109 S JEFFERY BLVD	CHICAGO	IL	60649-2425	07/01/2016	02/27/2025
CH056420	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #13832	4339 DIPAOLO CENTER	GLENVIEW	IL	60025	10/01/2016
CH056420	WALGREEN CO.	DBA: WALGREENS #15506	3303 W. 26TH STREET SUITE 101	CHICAGO	IL	60623	07/01/2017
CH056420	WALGREEN CO.	DBA: WALGREENS #15493	1333 W. BELMONT AVENUE	CHICAGO	IL	60657	07/01/2017	10/18/2024
CH056420	WALGREEN CO.	DBA: WALGREENS # 05124	8628 S COTTAGE GROVE AVE	CHICAGO	IL	60619	10/01/2017
CH056420	WALGREEN CO.	DBA: WALGREENS # 07267	650 W 63RD ST	CHICAGO	IL	60621-2012	10/01/2017
CH056420	WALGREEN CO.	DBA WALGREENS #16093	3040 S. CICERO AVE. SUITE A	CICERO	IL	60804	01/01/2018
CH056420	WALGREEN CO.	DBA: WALGREENS #13966	3249 S. OAK PARK AVE STE T1201	BERWYN	IL	60402	01/01/2018	09/30/2020
CH056420	WALGREEN CO.	DBA: WALGREENS # 06727	4720 N MARINE DRIVE	CHICAGO	IL	60640-5120	01/01/2018
CH056420	WALGREEN CO.	DBA: WALGREENS # 07179	2 E ROOSEVELT RD	CHICAGO	IL	60605-2410	04/01/2018
CH056420	WALGREEN CO.	DBA: WALGREENS # 07687	3320 W FULLERTON AVE	CHICAGO	IL	60647-2514	04/01/2018
CH056420	WALGREEN CO.	DBA: WALGREENS # 03539	11 E 75TH STREET	CHICAGO	IL	60619	04/01/2018
CH056420	WALGREEN CO.	DBA: WALGREENS # 00211	757 N MICHIGAN AVE	CHICAGO	IL	60611	07/01/2018
CH056420	WALGREEN CO.	DBA: WALGREENS # 09470	4817 W FULLERTON AVE	CHICAGO	IL	60639-2503	01/01/2019
CH056420	WALGREEN CO.	DBA: WALGREENS #13975	711 W NORTH AVE STE #204	CHICAGO	IL	60610	04/01/2019	09/18/2023
CH056420	WALGREEN CO.	DBA: WALGREENS # 00162	1554 E 55TH ST	CHICAGO	IL	60615	04/01/2019
CH056420	WALGREEN CO.	DBA: WALGREENS # 05825	1213 W 79TH STREET	CHICAGO	IL	60620-3706	04/01/2019
CH056420	WALGREEN CO.	DBA: WALGREENS # 01101	1533 E 67TH ST	CHICAGO	IL	60637-4426	04/01/2019
CH056420	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #16498	2351 E 71ST ST SUITE A	CHICAGO	IL	60649	04/01/2019
CH056420	WALGREEN CO.	DBA: WALGREENS # 00258	1650 W CHICAGO AVE	CHICAGO	IL	60622	10/01/2020
CH056420	WALGREEN CO.	DBA: WALGREENS # 13826	7200 W. NORTH AVE.	ELMWOOD PARK	IL	60707	04/01/2021
CH056420	WALGREEN CO.	DBA WALGREENS #15971	259 E. ERIE STREET SUITE 250	CHICAGO	IL	60611	04/01/2021
CH056420	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY #13974	225 E CHICAGO AVE STE 03110	CHICAGO	IL	60611	10/01/2021
CH056420	WALGREEN CO.	DBA: WALGREENS #21447	3513 N HALSTED ST	CHICAGO	IL	60657	10/01/2021
CH056420	WALGREEN CO.	DBA: WALGREENS # 05713	4740 W. 95TH STREET	OAK LAWN	IL	60453	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 09600	1445 W NORTH AVE	MELROSE PARK	IL	60160	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 05192	9148 S COMMERCIAL AVE	CHICAGO	IL	60617	01/01/2022	02/20/2025
CH056420	WALGREEN CO.	DBA: WALGREENS # 01450	4101 1ST AVE	LYONS	IL	60534	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 09709	4010 W LAWRENCE AVE	CHICAGO	IL	60630	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 09141	8700 S KEDZIE AVE	EVERGREEN PARK	IL	60805-1024	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 05684	8800 W 95TH ST	HICKORY HILLS	IL	60457	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 06629	8701 S CICERO AVE	HOMETOWN	IL	60456-1018	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 00249	1601 N WELLS	CHICAGO	IL	60614	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 09000	2001 N MILWAUKEE AVE	CHICAGO	IL	60647-4001	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #12304	2744 N. CALIFORNIA AVE	CHICAGO	IL	60647	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 07359	3222 N. MILWAUKEE AVENUE	CHICAGO	IL	60618-5106	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 06427	7878 S HARLEM AVE	BRIDGEVIEW	IL	60455	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #16000	6001 W 95TH ST	OAK LAWN	IL	60453	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 05962	4820 N CUMBERLAND AVE	NORRIDGE	IL	60706	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 05924	6430 W 111TH ST	WORTH	IL	60482	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 06762	11833 S WESTERN AVE	CHICAGO	IL	60643-4734	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 09038	4001 W IRVING PARK RD	CHICAGO	IL	60641-2926	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 00089	8715 S HARLEM AVE	BRIDGEVIEW	IL	60455	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 00252	7510 N WESTERN AVE	CHICAGO	IL	60645	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 03949	3046 N HALSTED ST	CHICAGO	IL	60657	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 03948	5140 W DIVERSEY AVE	CHICAGO	IL	60639	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 01449	8000 BROADVIEW VILLAGE SQUARE	BROADVIEW	IL	60155-2601	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 02387	1616 E 87TH STREET	CHICAGO	IL	60617-2727	01/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #15460	4440 WEST 95TH STREET SUITE 0201P	OAK LAWN	IL	60453	01/01/2022	04/02/2024
CH056420	WALGREEN CO.	DBA: WALGREENS # 13106	11801 S. AVENUE O	CHICAGO	IL	60617	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 00147	3611 E 106TH ST	CHICAGO	IL	60617	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 09033	7516 S CASS AVE STE 1	DARIEN	IL	60561	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 16355	2 N STATE ST #1	CHICAGO	IL	60602-1603	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 06980	3019 W PETERSON AVE	CHICAGO	IL	60659-3417	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 06462	9595 GRAND AVE	FRANKLIN PARK	IL	60131	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #15197	6121 N BROADWAY ST.	CHICAGO	IL	60660	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #15196	151 N. STATE ST.	CHICAGO	IL	60601-3601	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #15065	1601 N. MILWAUKEE AVE.	CHICAGO	IL	60647-5411	04/01/2022	01/31/2023
CH056420	WALGREEN CO.	DBA: WALGREENS # 06046	2151 S WOLF RD	HILLSIDE	IL	60162	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #16085	100 W. RANDOLPH STREET, UPPER 101	CHICAGO	IL	60601	04/01/2022	01/15/2024
CH056420	WALGREEN CO.	DBA: WALGREENS #13798	5440 N. CLARK ST.	CHICAGO	IL	60640	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #11332	4101 N HARLEM AVE	NORRIDGE	IL	60706	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 09438	30 N MICHIGAN AVE LBBY 1	CHICAGO	IL	60602	04/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS # 01173	1520 W FULLERTON	CHICAGO	IL	60614	04/01/2022
CH056420	WALGREEN CO.	DBA WALGREENS SPECIALTY PHARMACY#16501	6500 N CLARK ST SUITE 101	CHICAGO	IL	60626	10/01/2022
CH056420	WALGREEN CO.	DBA: WALGREENS #10485	12854 S ASHLAND AVE	CALUMET PARK	IL	60827-6308	04/01/2024
CH05642Y	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #13832	4339 DIPAOLO CENTER	GLENVIEW	IL	60025	10/01/2024	12/31/2024
CH05642J	WALGREEN CO.	DBA: WALGREENS # 01249	4800 W CERMAK RD	CICERO	IL	60804	10/01/2024	11/06/2024
CH05642C	WALGREEN CO.	DBA: WALGREENS # 00226	4005 W 26TH STREET	CHICAGO	IL	60623	10/01/2024	12/31/2024
CH05642Z	WALGREEN CO.	DBA: WALGREENS #15507	3800 W MADISON STREET SUITE 101	CHICAGO	IL	60624	10/01/2024	12/31/2024
CH05642D	WALGREEN CO.	DBA: WALGREENS # 00215	3045 W 26TH STREET	CHICAGO	IL	60623	10/01/2024	12/31/2024
CH05642G	WALGREEN CO.	WALGREENS SPECIALTY PHARMACY #16498	2351 E 71ST ST SUITE A	CHICAGO	IL	60649	10/01/2024	12/31/2024
CH05642X	WALGREEN CO.	DBA: WALGREENS # 05867	3943 W 47TH STREET	CHICAGO	IL	60632-4145	10/01/2024	12/31/2024
CH05642AB	WALGREEN CO.	DBA: WALGREENS #15506	3303 W. 26TH STREET SUITE 101	CHICAGO	IL	60623	10/01/2024	01/01/2025
CH05642AJ	WALGREEN CO.	DBA: WALGREENS # 01101	1533 E 67TH ST	CHICAGO	IL	60637-4426	10/01/2024	01/01/2025
CH056420	WALGREENS MAIL SERVICE, INC.	8350 S RIVER PARKWAY		TEMPE	AZ	85284	07/01/2013	07/09/2015
CH056420	WALGREENS MAIL SERVICE, INC.		8337 S PARK CIRCLE	ORLANDO	FL	32819-9049	07/01/2013	07/09/2015
CH056420	WALGREENS SPECIALTY PHARMACY, LLC	ALLIANCERX WALGREENS PRIME #12314	9775 SW GEMINI DR, STE 1	BEAVERTON	OR	97008	01/01/2019	10/01/2021
CH056420	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15438	41460 HAGGERTY CIR S	CANTON	MI	48188	01/01/2019
CH056420	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #15443	10530 JOHN W ELLIOTT DR STE 100	FRISCO	TX	75033	01/01/2019
CH056420	WALGREENS SPECIALTY PHARMACY, LLC	DBA WALGREENS SPECIALTY PHARMACY #16287	130 ENTERPRISE DR	PITTSBURGH	PA	15275	01/01/2019
CH056420	WALMART PHARMACY 10-3004	3320 S. CICERO AVE		CICERO	IL	60804	01/01/2024
CH056420	WALMART PHARMACY 10-5169	2252 NORTH 8TH STREET	SUITE A	ROGERS	AR	72756	04/01/2023
CH056420	Walmart Pharmacy 10-7611	2501 Perry Rd		Plainfield	IN	46168	01/01/2024

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	State	Update		To Be Terminated	Terminated	10/1/2024 12:01 AM
Dates	Last Date That 340B Drugs Purchased	Update	Termination Request		6/1/2024 12:00:00 AM	7/5/2024 10:11 AM
Details	State	Update	Termination Request	Active	To Be Terminated	7/5/2024 10:11 AM
Terminations	Termination Date	Update	Termination Request		10/1/2024 12:00:00 AM	7/5/2024 10:11 AM
Terminations	Termination Effective Date	Update	Termination Request		6/1/2024 12:00:00 AM	7/5/2024 10:11 AM
Terminations	Termination Reason	Update	Termination Request		Site closure	7/5/2024 10:11 AM
Details	State	Update		Approved	Active	4/1/2024 12:01 AM
Contacts	Authorizing Official	Update	Group Change Request	Sianghio, Alyssa Chief Administrative Officer (CAO) Lawndale Christian Health Center 8725883015	Dons, Christopher Robert Chief Financial Officer Lawndale Christian Health Center 8725883032	3/25/2024 11:04 AM
Medicaid Billing	Medicaid: Number	Delete	Change Request	363308953-01 (IL)		1/31/2024 12:04 PM
Medicaid Billing	Medicaid: Is Primary	Insert	Change Request		False	1/31/2024 12:04 PM
Medicaid Billing	Medicaid: Number	Insert	Change Request		363308953001	1/31/2024 12:04 PM
Medicaid Billing	Medicaid: State	Insert	Change Request		IL	1/31/2024 12:04 PM
Contacts	Signed By	Insert	New Registration		Sianghio, Alyssa Chief Administrative Officer (CAO) Lawndale Christian Health Center 8725883015	1/10/2024 6:50 AM
Details	340B ID	Update	New Registration		CH05642AC	1/10/2024 6:50 AM
Dates	Participating Approval Date	Update	New Registration		1/10/2024 6:50:08 AM	1/10/2024 6:50 AM
Details	State	Update	New Registration	Pending	Approved	1/10/2024 6:50 AM
Dates	Signed By Date	Update	New Registration		1/9/2024 3:00:44 PM	1/10/2024 6:50 AM
Dates	Start Date	Update	New Registration		4/1/2024 12:00:00 AM	1/10/2024 6:50 AM
Addresses	Main Address	Insert	New Registration		5801 N Pulaski Road BLDG H Chicago, IL 60646	1/9/2024 3:00 PM
Addresses	Billing Address	Insert	New Registration		LAWNDALE CHRISTIAN HLTH CTR 3860 WEST OGDEN AVENUE CHICAGO, IL 60623	1/9/2024 3:00 PM
Addresses	Shipping Address	Insert	New Registration		LAWNDALE CHRISTIAN HLTH CTR 3860 WEST OGDEN AVENUE CHICAGO, IL 60623	1/9/2024 3:00 PM
Medicaid Billing	Medicaid: Is Primary	Insert	New Registration		False	1/9/2024 3:00 PM
Medicaid Billing	Medicaid: Number	Insert	New Registration		363308953-01	1/9/2024 3:00 PM
Medicaid Billing	Medicaid: State	Insert	New Registration		IL	1/9/2024 3:00 PM
Medicaid Billing	NPI: Number	Insert	New Registration		1245289214	1/9/2024 3:00 PM
Medicaid Billing	NPI: State	Insert	New Registration		IL	1/9/2024 3:00 PM
Contacts	Authorizing Official	Insert	New Registration		Sianghio, Alyssa Chief Administrative Officer (CAO) Lawndale Christian Health Center 8725883015	1/9/2024 3:00 PM
Contacts	Primary Contact	Insert	New Registration		Cueto, Alexandra Internal Auditor Lawndale Christian Health Center 8725883027	1/9/2024 3:00 PM
Details	Assistance Received From Date	Insert	New Registration			1/9/2024 3:00 PM
Details	Assistance Received To Date	Insert	New Registration			1/9/2024 3:00 PM
Details	Last Recertification Date	Insert	New Registration			1/9/2024 3:00 PM
Details	Grant Number	Insert	New Registration		H80CS00725	1/9/2024 3:00 PM
Details	340B ID	Insert	New Registration			1/9/2024 3:00 PM
Details	Is Authorizing Official EHB Data	Insert	New Registration			1/9/2024 3:00 PM
Dates	Last Date That 340B Drugs Purchased	Insert	New Registration			1/9/2024 3:00 PM
Details	Medicare Provider Number	Insert	New Registration			1/9/2024 3:00 PM
Details	Entity Name	Insert	New Registration		LAWNDALE CHRISTIAN HEALTH CENTER	1/9/2024 3:00 PM
Details	NOFO Number	Insert	New Registration			1/9/2024 3:00 PM
Details	Program Code	Insert	New Registration		CH	1/9/2024 3:00 PM
Details	Entity Subname	Insert	New Registration		Temporary Site - North Park Village Apartments	1/9/2024 3:00 PM
Dates	Participating Approval Date	Insert	New Registration			1/9/2024 3:00 PM
Details	State	Insert	New Registration		Pending	1/9/2024 3:00 PM
Dates	Registration Date	Insert	New Registration		1/9/2024 3:00:39 PM	1/9/2024 3:00 PM
Dates	Signed By Date	Insert	New Registration			1/9/2024 3:00 PM
Dates	Start Date	Insert	New Registration			1/9/2024 3:00 PM
Terminations	Termination Comments	Insert	New Registration			1/9/2024 3:00 PM
Terminations	Termination Date	Insert	New Registration			1/9/2024 3:00 PM
Terminations	Termination Effective Date	Insert	New Registration			1/9/2024 3:00 PM
Terminations	Termination Reason	Insert	New Registration			1/9/2024 3:00 PM

340B Drug Pricing Program Database