340B Drug Pricing Program Database


CHC00341-09 PRIMECARE COMMUNITY HEALTH INC (Terminated) - information as of 5/5/2025 11:51:13 PM

Main Details
PRIMECARE COMMUNITY HEALTH INC
Elston
HRSA-Funded Health Center
BPS-H80-038466
CHC00341-09
H80CS00341


Additional Details
Terminated
7/8/2024
10/1/2024
9/12/2024

1/1/2025
Site closure

Contacts

PrimeCare Community Health
Michael C Holtrop, Chief Financial Officer
(616) 482-9892

PRIMECARE COMMUNITY HEALTH INC
Kenzie Keisler, Interim 340B Compliance Analyst
(803) 465-2011

Addresses

1308 N Elston Ave
Chicago, IL 60642-2416

Same as Street Address


  • Comments
  • Medicaid Billing
  • Shipping Addresses
  • Contract Pharmacies
  • Grantee Sites
  • Grantee Sites Contract Pharmacies
  • History
Comments
CommentLast Updated On 
No records to display.
Medicaid Billing

No
Shipping Addresses

Same as Street Address
Grantee Sites
340B ID 340B StatusSiteIdNameSub NameAddressAddress Cont.CityState
CHC00341-00ActiveBPS-H80-002087PRIMECARE COMMUNITY HEALTH INCPRIMECARE WEST TOWN1431 N Western Ave ChicagoIL
CHC00341-01ActiveBPS-H80-001933PRIMECARE COMMUNITY HEALTH INCPRIMECARE FULLERTON3924 W Fullerton Ave ChicagoIL
CHC00341-02ActiveBPS-H80-027459PRIMECARE COMMUNITY HEALTH INCPrimeCare Belmont Cragin5635 West Belmont ChicagoIL
CHC00341-03ActiveBPS-H80-011484PRIMECARE COMMUNITY HEALTH INCPrimeCare Northwest1649 N Pulaski Rd ChicagoIL
CHC00341-04ActiveBPS-H80-012113PRIMECARE COMMUNITY HEALTH INCPrimeCare Hamlin1920 N Hamlin ChicagoIL
CHC00341-05ActiveBPS-H80-018009PRIMECARE COMMUNITY HEALTH INCPrimeCare Wicker Park1127 N. Oakley Blvd. ChicagoIL
CHC00341-06ActiveBPS-H80-018449PRIMECARE COMMUNITY HEALTH INCMichael Michelini Center for Health1431 N Western Ave ChicagoIL
CHC00341-07ActiveBPS-H80-018120PRIMECARE COMMUNITY HEALTH INCPrimeCare West Town Dental1431 N Western Ave ChicagoIL
CHC00341-08ActiveBPS-H80-036204PrimeCare Community Health, Inc.PrimeCare Young Family Health Center1431 N Western Ave ChicagoIL
CHC00341-09TerminatedBPS-H80-038466PRIMECARE COMMUNITY HEALTH INCElston1308 N Elston Ave ChicagoIL
Grantee Sites Contract Pharmacies
340B IDPharmacy NameAddressAddress Cont.CityStateZip CodeBegin DateCarve-In Effective DateTermination Date
CHC00341-00ACCREDO HEALTH GROUP INC2040 W RIO SALADO PKWY STE 101B
TEMPEAZ85281-201007/01/2024  
CHC00341-00ACCREDO HEALTH GROUP INC3000 ERICSSON DRIVE, SUITE 100
WARRENDALEPA15086-750207/01/2024  
CHC00341-00ACCREDO HEALTH GROUP INC1620 CENTURY CENTER PKWY # 109
MEMPHISTN38134-884907/01/2024  
CHC00341-00ACCREDO HEALTH GROUP, INC.6272 LEE VISTA BLVD STE 100
ORLANDOFL3282207/01/2024  
CHC00341-00ACCREDO HEALTH GROUP, INC.2 BOULDEN CIR STE 1
NEW CASTLEDE19720-349207/01/2024  
CHC00341-00ACCREDO HEALTH GROUP, INC.4750 E 450 S SUITE A
WHITESTOWNIN4607507/01/2024  
CHC00341-00ADVANCED CARE SCRIPTS, INCCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 6251 CHANCELLOR DRIVE
SUITE 101
ORLANDOFL3280901/01/2020  
CHC00341-00AHSSHCEXPEDIEN RX PHARMACY 5050 WESLEY RD STE 120
APOPKAFL3271204/01/2020 01/01/2025
CHC00341-00AMAZON PHARMACY #0014500 S PLEASANT VALLEY RD STE 201
AUSTINTX78744-291110/01/2019 01/01/2025
CHC00341-00AMAZON PHARMACY #0063620 PLAINFIELD RD
INDIANAPOLISIN46231-700310/01/2024  
CHC00341-00AMAZON PHARMACY #008408 TECHNOLOGY PARKWAY BUILDING B, STE 101
COLLEGE STATIONTX7784510/01/2024 01/01/2025
CHC00341-00AMAZON PHARMACY #0097469 KINGSPOINTE PKWY STE 400
ORLANDOFL3281910/01/2024 01/01/2025
CHC00341-00AMAZON PHARMACY #0101331 E 6TH ST
CORONACA9287910/01/2024 01/01/2025
CHC00341-00AMERICAN DRUG STORES LLCDBA OSCO DRUG 1403 7122 40TH ST
STICKNEYIL60402-419801/01/2025  
CHC00341-00AMERICAN DRUG STORES LLCDBA OSCO DRUG 3262 4660 W. IRVING PARK ROAD
CHICAGOIL6064101/01/2025  
CHC00341-00AMERICAN DRUG STORES LLCDBA OSCO DRUG 1241 1343 N. PAULINA ST.
CHICAGOIL6062201/01/2025  
CHC00341-00ARMITAGE PHARMACY, INC.3650 W ARMITAGE AVE
CHICAGOIL60647-361107/01/2025  
CHC00341-00AZ PHARMACY, LLCDBA AMAZON PHARMACY #002 3809 E WATKINS ST
PHOENIXAZ8503410/01/2019  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC376 NORTHLAKE BLVD
ALTAMONTE SPRINGSFL32701-526104/01/2020  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC4900 PROSPECTUS DR STE 300
DURHAMNC2771304/01/2020  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 145 S 79TH ST STE 70
CHANDLERAZ8522604/01/2025  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLCBIOPLUS SPECIALTY PHARMACY SERVICES, LLC 4740 VICTORY LN STE C
INDIANAPOLISIN4620304/01/2025  
CHC00341-00BIOPLUS SPECIALTY PHARMACY SERVICES, LLC13925 YALE AVE STE 145
IRVINECA92620-267004/01/2025  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01495 4225 W. ARMITAGE
CHICAGOIL6063910/01/2014 08/11/2015
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02877 2440 W NORTH AVE
CHICAGOIL6064710/01/2014  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04147 1546 N. CENTRAL AVE.
CHICAGOIL60651-125910/01/2014  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04938 4748 W NORTH AVE
CHICAGOIL6063910/01/2014  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 11410 1627 N PULASKI RD
CHICAGOIL6063910/01/2014  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01310 3110 W ARMITAGE
CHICAGOIL6064707/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05121 5935 W ADDISON
CHICAGOIL6063407/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03833 2828 N HARLEM
ELMWOOD PARKIL6070710/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS #10771 6460 W. FULLERTON AVE
CHICAGOIL6070710/01/2015 06/27/2017
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01593 5230 N MILWAUKEE AVE
CHICAGOIL6063010/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04935 6809 W BELMONT AVE
CHICAGOIL6063410/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04936 4040 N. CICERO AVE.
CHICAGOIL6064110/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04986 4745 W BELMONT AVE
CHICAGOIL60641-441010/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04233 5600 W. FULLERTON
CHICAGOIL6063910/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04862 4343 N CENTRAL AVE
CHICAGOIL6063410/01/2015  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05057 3153 W IRVING PARK RD
CHICAGOIL6061807/01/2016  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04542 5625 N. RIDGE AVE
CHICAGOIL60660-343401/01/2017  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01298 1372 N MILWAUKEE AVE
CHICAGOIL6062204/01/2017  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03961 2340 W MADISON ST
CHICAGOIL6061207/01/2019  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05235 6412 ROOSEVELT RD
OAK PARKIL60304-213507/01/2019  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 01417 1931 W CERMAK RD
CHICAGOIL6060804/01/2020  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03395 3401 W ROOSEVELT RD
CHICAGOIL6062404/01/2020 11/12/2024
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA WALGREENS SPECIALTY PHARMACY #04505 4025 N. SHERIDAN RD.
CHICAGOIL6061304/01/2020  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02903 5222 WEST MADISON ST
CHICAGOIL6064404/01/2021  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05103 5932 W. CERMAK RD
CICEROIL6080401/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04978 111 S. HALSTED STREET
CHICAGOIL6066101/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05234 5435 S KEDZIE AVE
CHICAGOIL6063201/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 05356 4710 S WESTERN AVE
CHICAGOIL6060901/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04826 9800 IRVING PARK ROAD
SCHILLER PARKIL6017601/01/2022  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02586 2301 W. IRVING PARK
CHICAGOIL6061801/01/2022  
CHC00341-06BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 02877 2440 W NORTH AVE
CHICAGOIL6064701/01/2024  
CHC00341-04BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04233 5600 W. FULLERTON
CHICAGOIL6063904/01/2024  
CHC00341-08BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04935 6809 W BELMONT AVE
CHICAGOIL6063407/01/2024  
CHC00341-03BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 11410 1627 N PULASKI RD
CHICAGOIL6063907/01/2024  
CHC00341-02BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04935 6809 W BELMONT AVE
CHICAGOIL6063407/01/2024  
CHC00341-03BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 04233 5600 W. FULLERTON
CHICAGOIL6063907/01/2025  
CHC00341-00BOND DRUG COMPANY OF ILLINOIS, L.L.C.DBA: WALGREENS # 03779 100 LAKE ST
MAYWOODIL6015307/01/2025  
CHC00341-00CAREMARK FLORIDA SPECIALTY PHARMACY LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7930 WOODLAND CENTER BLVD STE 500
TAMPAFL3361401/01/2020  
CHC00341-00CAREMARK ILLINOIS SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 800 BIERMANN CT STE B
MOUNT PROSPECTIL6005601/01/2020  
CHC00341-00CAREMARK KANSAS SPECIALTY PHARMACYCVS/SPECIALTY OR CARELONRX SPECIALTY PHA 11162 RENNER BLVD
LENEXAKS6621901/01/2020  
CHC00341-00CAREMARK MASSACHUSETTS SPECIALTY PHARMACDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 25 BIRCH STREET, BLDG B, SUITE 100
MILFORDMA0175701/01/2020  
CHC00341-00CAREMARK MICHIGAN SPECIALTY PHARMACY, LLDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1307 ALLEN DR STE H
TROYMI4808301/01/2020  
CHC00341-00CAREMARK NEW JERSEY SPECIALTY PHCY, LLCDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 180 PASSAIC AVE UNIT B-5
FAIRFIELDNJ0700401/01/2020  
CHC00341-00CAREMARK NORTH CAROLINA SPECIALTY PHARMADBA CVS/SPECIALTY OR CARELONRX SPECIALTY 10700 WORLD TRADE BLVD STE 110
RALEIGHNC2761701/01/2020  
CHC00341-00CAREMARK TENNESSEE SPECIALTY PHARMACY, LDBA CVS/SPECIALTY OR CARELONRX SPECIALTY 8370 WOLF LAKE DR
STE 107
BARTLETTTN3813301/01/2020  
CHC00341-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 1127 BRYN MAWR AVE
SUITE A
REDLANDSCA9237401/01/2020  
CHC00341-00CAREMARK, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 7251 S. EASTERN AVE.
LAS VEGASNV8911910/01/2021  
CHC00341-00CVS CAREMARKDBA CVS/CAREMARK OR CF# 11506 1 GREAT VALLEY BOULEVARD
WILKES BARREPA1870604/01/2021  
CHC00341-00CVS CAREMARK ADVANCED TECHNOLOGY PHARMACDBA CVS/CAREMARK 48067 1780 WALL ST
MT PROSPECTIL6005604/01/2021  
CHC00341-00CVS/SPECIALTY OR CARELONRX SPECIALTY PHACAREMARK, LLC 1001 SPINKS ROAD, STE 280
FLOWER MOUNDTX7502810/01/2021  
CHC00341-00CYSTIC FIBROSIS SERVICES, LLCDBA WALGREENS SPECIALTY PHARMACY #16280 10530 JOHN W ELLIOTT DR STE 200
FRISCOTX7503301/21/2021  
CHC00341-00DOGWOOD PHARMACY, INCD/B/A MEDSCRIPTS MEDICAL PHARMACY 1325 MILLER ROAD
SUITE K
GREENVILLESC29607-654004/01/2020  
CHC00341-00EAM GROUP, LLC.ANVIRX PHARMACY 13925 YALE AVE STE 145
IRVINECA9262010/01/2022 12/27/2024
CHC00341-00ESI MAIL PHARMACY SERVICEDBA EXPRESS SCRIPTS 7909 S HARDY DR STE 106
TEMPEAZ85284-111207/01/2024  
CHC00341-00EXACT CARE PHARMACYDDCRX, LLC 2701 HIGHPOINT OAKS DR STE 100
LEWISVILLETX75067-389610/01/2022 12/27/2024
CHC00341-00EXACT CARE PHARMACY, LLC8333 ROCKSIDE RD
CLEVELANDOH4412510/01/2022 12/27/2024
CHC00341-00EXPRESS SCRIPTSESI MAIL PHARMACY SERVICE INC 4600 N HANLEY RD
SAINT LOUISMO6313407/01/2024  
CHC00341-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 4750 E. 450 S.
WHITESTOWNIN4607507/01/2024  
CHC00341-00EXPRESS SCRIPTS PHARMACY, INC.DBA EXPRESS SCRIPTS 2040 ROUTE 130 NORTH
BURLINGTONNJ0801607/01/2024  
CHC00341-00GENOA HEALTHCARE LLCN171 W21840 CAYMUS CT
JACKSONWI5303704/01/2024  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 00788 344 WEST HUBBARD
CHICAGOIL6065410/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 01054 101 N. CLINTON ST.
CHICAGOIL6066110/01/2019 07/14/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 01493 5205 N. BROADWAY ST.
CHICAGOIL6064010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02809 2815 N. WESTERN AVE.
CHICAGOIL6061810/01/2019 01/19/2023
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02862 3944 N. WESTERN AVE.
CHICAGOIL6061810/01/2019 10/11/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02934 208 W. WASHINGTON ST.
CHICAGOIL6060610/01/2019 10/11/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02942 401 W. ARMITAGE AVE.
CHICAGOIL6061410/01/2019 01/31/2024
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02981 1201 N. STATE ST.
CHICAGOIL6061010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 03742 121 W KINZIE ST
CHICAGOIL6065410/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 04781 205 N. MICHIGAN AVE.
CHICAGOIL6060110/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 04793 1211 W. ROOSEVELT RD.
CHICAGOIL6060810/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05001 3033 N. BROADWAY ST.
CHICAGOIL6065710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA CVS/PHARMACY # 5394 1200 N. ASHLAND, UNIT C-1
CHICAGOIL6062210/01/2019 03/07/2023
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05482 3615 N. CENTRAL AVE
CHICAGOIL6063410/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05681 3311 N. PULASKI RD.
CHICAGOIL6064110/01/2019 11/14/2024
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05768 130 S. CANAL ST.
CHICAGOIL6060610/01/2019 04/14/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05770 4777 N. MILWAUKEE AVE.
CHICAGOIL6063010/01/2019 10/11/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05836 1228 E. 53RD ST.
CHICAGOIL6061510/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05987 4800 NORTH DAMEN
CHICAGOIL6062510/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 06785 3343 W. MONTROSE AVE.
CHICAGOIL6061810/01/2019 06/15/2023
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08519 11055 S. WESTERN AVENUE
CHICAGOIL6064310/01/2019 05/16/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08695 3101 N. CLARK
CHICAGOIL6065710/01/2019 04/13/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08698 1165 N. CLARK
CHICAGOIL6061010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08731 400 W MADISON ST
CHICAGOIL6060610/01/2019 08/08/2024
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08735 3940 WEST FULLERTON
CHICAGOIL6064710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08737 2414 N. LINCOLN AVE.
CHICAGOIL6061410/01/2019 04/14/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08739 1819 N. HARLEM AVENUE
CHICAGOIL6070710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08740 2427 W CHICAGO AVE
CHICAGOIL6062210/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08745 771 N OGDEN AVE
CHICAGOIL6064210/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08747 6150 N BROADWAY
CHICAGOIL6066010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08750 4801 N CENTRAL
CHICAGOIL6063010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08751 4051 N LINCOLN
CHICAGOIL6061810/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08753 3637 N SOUTHPORT
CHICAGOIL6061310/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08756 6200 W HIGGINS
CHICAGOIL6063010/01/2019 05/16/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08910 205 N COLUMBUS DR
CHICAGOIL6060110/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08980 6510 NORTH SHERIDAN RD.
CHICAGOIL6062610/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 16361 2656 N ELSTON AVE
CHICAGOIL6064710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 16771 2939 W ADDISON ST
CHICAGOIL6061810/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17042 6525 W DIVERSEY AVE
CHICAGOIL6070710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17167 2112 W PETERSON AVE
CHICAGOIL6065910/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17437 4466 N BROADWAY ST
CHICAGOIL6064010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17591 1200 N LARRABEE ST
CHICAGOIL6061010/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17634 1101 W JACKSON BLVD
CHICAGOIL6060710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 17683 2650 N CLARK ST
CHICAGOIL6061410/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 17686 1346 E 53RD ST
CHICAGOIL6061510/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 17698 3204 NORTH CLARK ST.
CHICAGOIL6065710/01/2019  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 03163 345 MADISON ST.
OAK PARKIL6030204/01/2020  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08502 6315 S PULASKI RD STE 1
CHICAGOIL6062904/01/2020  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08742 5524 W CERMAK RD, STE 1
CICEROIL6080404/01/2020  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02844 6748 ROOSEVELT RD.
OAK PARKIL6030401/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05769 470 S. TORRENCE AVE.
CALUMET CITYIL6040901/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05978 3434 DEMPSTER ST.
SKOKIEIL6007601/01/2021 10/11/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 07142 16760 W. DIVISION ST.
LOCKPORTIL6044101/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08741 2634 S PULASKI
CHICAGOIL6062301/01/2021 07/14/2022
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08757 4001 MAIN ST.
SKOKIEIL6007601/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02846 8639 S. CICERO AVE.
CHICAGOIL6065210/01/2021 01/14/2024
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 16999 4433 S PULASKI RD
CHICAGOIL6063210/01/2021  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS/PHARMACY # 10942 310 SOUTH MICHIGAN AVE
CHICAGOIL6060407/01/2022  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17536 130 S MANNHEIM RD
HILLSIDEIL6016210/01/2022  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02663 225 WEST COURT ST
KANKAKEEIL6090110/01/2022  
CHC00341-00HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17008 4050 N HARLEM AVE
NORRIDGEIL6070601/01/2023  
CHC00341-00HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 02827 600 NORTH MANNHEIM RD.
HILLSIDEIL6016201/01/2023  
CHC00341-04HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 17042 6525 W DIVERSEY AVE
CHICAGOIL6070701/01/2024  
CHC00341-07HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08740 2427 W CHICAGO AVE
CHICAGOIL6062201/01/2024  
CHC00341-01HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 08735 3940 WEST FULLERTON
CHICAGOIL6064701/01/2024  
CHC00341-08HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05482 3615 N. CENTRAL AVE
CHICAGOIL6063401/01/2024  
CHC00341-05HIGHLAND PARK CVS, L.L.C.CVS PHARMACY # 16361 2656 N ELSTON AVE
CHICAGOIL6064701/01/2024  
CHC00341-03HIGHLAND PARK CVS, L.L.C.DBA: CVS/PHARMACY # 05681 3311 N. PULASKI RD.
CHICAGOIL6064101/01/2024 11/13/2024
CHC00341-00IC PHARMACY LLCAMAZON PHARMACY #004 34 35TH STREET
STE 4BSW, UNIT 28
BROOKLYNNY1123210/01/2024 01/01/2025
CHC00341-00M.N. PHARMACY LLCDBA AMAZON PHARMACY #003 6701 NW 7TH ST., STE. #199
MIAMIFL3312610/01/2019 01/01/2025
CHC00341-00OPTUM PHARMACY 700, LLC19 CHAPIN RD BLDG D, STE D8
PINE BROOKNJ0705804/01/2024  
CHC00341-00OPTUM PHARMACY 701, LLC1830 S HORNE
MESAAZ8520404/01/2024  
CHC00341-00OPTUM PHARMACY 701, LLC4015 SHOPTON RD STE 600
CHARLOTTENC28217-302504/01/2024  
CHC00341-00OPTUMRXOPTUMRX INC 6800 W 115TH ST STE 600
OVERLAND PARKKS66211-983804/01/2024  
CHC00341-00PILLPACK LLCDBA PILLPACK BY AMAZON PHARMACY 250 COMMERCIAL ST STE 2012
MANCHESTERNH0310110/01/2019  
CHC00341-00PILLPACK LLCAMAZON PHARMACY #005 20416 72ND AVE S
KENTWA98032-231910/01/2024 01/01/2025
CHC00341-00PRESENCE NAZARETH FAMILY CENTERPHARMACY 1127 N. OAKLEY BLVD
CHICAGOIL6062204/01/2023 10/30/2023
CHC00341-00PRIME THERAPEUTICS SPECIALTY PHARMACY LLALLIANCERX WALGREENS PRIME #16568 2354 COMMERCE PARK DRIVE
SUITE 100
ORLANDOFL32819-999201/21/2021 10/01/2022
CHC00341-00PROCARE PHARMACY DIRECT, L.L.C.DBA CVS/SPECIALTY OR CARELONRX SPECIALTY 105 MALL BOULEVARD
MONROEVILLEPA1514601/01/2020  
CHC00341-00PROCARE PHARMACY, L.L.C.DBA: CVS/PHARMACY #2909 1521 4TH AVE., SOUTH
BIRMINGHAMAL3523301/01/2020  
CHC00341-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY OR CARELONRX SPECIALTY ONE WATERFRONT PLAZA
500 ALA MOANA BLVD., BLDG 1
HONOLULUHI9681301/01/2020  
CHC00341-00PROCARE PHARMACY, L.L.C.DBA CVS/PHARMACY #2923 3250 HARDEN ST. EXT. SUITE #300
COLUMBIASC2920310/01/2021  
CHC00341-00RAINA RX LLCDBA ROUTE 300 PHARMACY 1208 ROUTE 300
SUITE 103
NEWBURGHNY1255004/01/2020  
CHC00341-00RIVER MEDICAL PHARMACY LLC4752 RESEARCH DR
SAN ANTONIOTX78240-500204/01/2020 12/27/2024
CHC00341-00SHEFFIELD AVENUE CVS, L.L.C.DBA: CVS/PHARMACY # 03690 1714 N. SHEFFIELD AVE.
CHICAGOIL6061410/01/2019  
CHC00341-00SOUTH WABASH CVS, L.L.C.DBA: CVS/PHARMACY # 03674 105 S. WABASH AVE.
CHICAGOIL6060310/01/2019 04/14/2022
CHC00341-00TRUEPILL3121 DIABLO AVE
HAYWARDCA9454510/23/2020 12/31/2024
CHC00341-00WAL-MART CENTRAL FILL 10-2670608 SPRING HILL DR # 3 SUITE 300
SPRINGTX7738607/01/2019  
CHC00341-00WAL-MART PHARMACY 10-54024650 WEST NORTH AVE
CHICAGOIL6063907/01/2019  
CHC00341-00WAL-MART PHARMACY 10-56174626 W DIVERSEY AVE.
CHICAGOIL6063907/01/2019  
CHC00341-00WAL-MART PHARMACY 10-59979600 PARKSOUTH CT. SUITE 100
ORLANDOFL3283707/01/2019  
CHC00341-00WALGREEN ARIZONA DRUG CO.WALGREENS CENTRAL FILL #21372 120 N 83RD AVE
STE 200
TOLLESONAZ8535307/01/2022  
CHC00341-00WALGREEN CODBA: WALGREENS #15525 201 E. HURON STREET, SUITE 01-210
CHICAGOIL6061107/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 03948 5140 W DIVERSEY AVE
CHICAGOIL6063910/01/2014  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 07359 3222 N. MILWAUKEE AVENUE
CHICAGOIL60618-510610/01/2014  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09470 4817 W FULLERTON AVE
CHICAGOIL60639-250310/01/2014  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 10424 3934 W DIVERSEY AVE
CHICAGOIL6064710/01/2014 06/18/2015
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00118 5650 W BELMONT AVE
CHICAGOIL6063407/01/2015 11/19/2020
CHC00341-00WALGREEN CO.DBA: WALGREENS # 07687 3320 W FULLERTON AVE
CHICAGOIL60647-251407/01/2015  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09000 2001 N MILWAUKEE AVE
CHICAGOIL60647-400107/01/2015  
CHC00341-00WALGREEN CO.DBA: WALGREENS #11332 4101 N HARLEM AVE
NORRIDGEIL6070610/01/2015  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 05962 4820 N CUMBERLAND AVE
NORRIDGEIL6070610/01/2015  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00829 8361 BELMONT AVE
RIVER GROVEIL6017107/01/2016  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 10649 3424 W BELMONT AVE
CHICAGOIL6061807/01/2016  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09709 4010 W LAWRENCE AVE
CHICAGOIL6063007/01/2016  
CHC00341-00WALGREEN CO.DBA: WALGREENS #12304 2744 N. CALIFORNIA AVE
CHICAGOIL6064707/01/2016  
CHC00341-00WALGREEN CO.DBA: WALGREENS #15065 1601 N. MILWAUKEE AVE.
CHICAGOIL60647-541101/01/2017 01/31/2023
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00258 1650 W CHICAGO AVE
CHICAGOIL6062207/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 01249 4800 W CERMAK RD
CICEROIL6080407/01/2019 11/06/2024
CHC00341-00WALGREEN CO.DBA: WALGREENS # 03950 4343 N KEDZIE AVE
CHICAGOIL6061807/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 06641 1614 W 47TH STREET
CHICAGOIL60609-324507/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 06727 4720 N MARINE DRIVE
CHICAGOIL60640-512007/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09038 4001 W IRVING PARK RD
CHICAGOIL60641-292607/01/2019  
CHC00341-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY #09399 2835 N SHEFFIELD AVE STE 505
CHICAGOIL6065707/01/2019  
CHC00341-00WALGREEN CO.WALGREENS SPECIALTY PHARMACY #15305 912 W BELMONT AVE
CHICAGOIL6065707/01/2019  
CHC00341-00WALGREEN CO.DBA: WALGREENS #15507 3800 W MADISON STREET SUITE 101
CHICAGOIL6062407/01/2019  
CHC00341-00WALGREEN CO.WALGREENS SPECIALTY PHARMACY #16498 2351 E 71ST ST
SUITE A
CHICAGOIL6064907/01/2019  
CHC00341-00WALGREEN CO.WALGREENS SPECIALTY PHARMACY #13832 4339 DIPAOLO CENTER
GLENVIEWIL6002504/01/2020  
CHC00341-00WALGREEN CO.DBA: WALGREENS #13975 711 W NORTH AVE STE #204
CHICAGOIL6061010/01/2020 09/18/2023
CHC00341-00WALGREEN CO.DBA: WALGREENS #15493 1333 W. BELMONT AVENUE
CHICAGOIL6065710/01/2020  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 07515 7155 W FOSTER PLACE
CHICAGOIL60656-361404/01/2021  
CHC00341-00WALGREEN CO.DBA: WALGREENS #21447 3513 N HALSTED ST
CHICAGOIL6065710/01/2021  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00194 4801 N LINCOLN AVE
CHICAGOIL6062501/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 13826 7200 W. NORTH AVE.
ELMWOOD PARKIL6070701/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 00259 3358 N WESTERN
CHICAGOIL6061801/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 05926 4385 S ARCHER AVE
CHICAGOIL6063201/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 06462 9595 GRAND AVE
FRANKLIN PARKIL6013101/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS # 09600 1445 W NORTH AVE
MELROSE PARKIL6016001/01/2022  
CHC00341-00WALGREEN CO.DBA WALGREENS SPECIALTY PHARMACY#16501 6500 N CLARK ST
SUITE 101
CHICAGOIL6062601/01/2022  
CHC00341-00WALGREEN CO.DBA: WALGREENS #15506 3303 W. 26TH STREET
SUITE 101
CHICAGOIL6062301/01/2022  
CHC00341-00WALGREEN CO.DBA WALGREENS #16093 3040 S. CICERO AVE.
SUITE A
CICEROIL6080401/01/2022  
CHC00341-00WALGREEN CO.DBA WALGREENS #15971 259 E. ERIE STREET
SUITE 250
CHICAGOIL6061110/01/2022  
CHC00341-02WALGREEN CO.DBA: WALGREENS # 09000 2001 N MILWAUKEE AVE
CHICAGOIL60647-400101/01/2024  
CHC00341-07WALGREEN CO.DBA: WALGREENS # 07359 3222 N. MILWAUKEE AVENUE
CHICAGOIL60618-510607/01/2024  
CHC00341-03WALGREEN CO.DBA: WALGREENS # 09470 4817 W FULLERTON AVE
CHICAGOIL60639-250307/01/2024  
CHC00341-05WALGREEN CO.DBA: WALGREENS # 03948 5140 W DIVERSEY AVE
CHICAGOIL6063907/01/2024  
CHC00341-08WALGREEN CO.DBA: WALGREENS # 03948 5140 W DIVERSEY AVE
CHICAGOIL6063907/01/2024  
CHC00341-07WALGREEN CO.DBA: WALGREENS # 09000 2001 N MILWAUKEE AVE
CHICAGOIL60647-400107/01/2024  
CHC00341-05WALGREEN CO.DBA: WALGREENS # 09470 4817 W FULLERTON AVE
CHICAGOIL60639-250307/01/2024  
CHC00341-06WALGREEN CO.DBA: WALGREENS # 07359 3222 N. MILWAUKEE AVENUE
CHICAGOIL60618-510607/01/2024  
CHC00341-00WALGREENS MAIL SERVICE, INC.  8337 S PARK CIRCLE
ORLANDOFL32819-904910/01/2014 07/02/2015
CHC00341-00WALGREENS MAIL SERVICE, INC.8350 S RIVER PARKWAY
TEMPEAZ8528410/01/2014 07/02/2015
CHC00341-00WALGREENS SPECIALTY PHARMACY, LLCALLIANCERX WALGREENS PRIME #12314 9775 SW GEMINI DR, STE 1
BEAVERTONOR9700801/21/2021 10/01/2021
CHC00341-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15438 41460 HAGGERTY CIR S
CANTONMI4818801/21/2021  
CHC00341-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #15443 10530 JOHN W ELLIOTT DR STE 100
FRISCOTX7503301/21/2021  
CHC00341-00WALGREENS SPECIALTY PHARMACY, LLCDBA WALGREENS SPECIALTY PHARMACY #16287 130 ENTERPRISE DR
PITTSBURGHPA1527501/21/2021  
CHC00341-00WALMART PHARMACY 10-51692252 NORTH 8TH STREET
SUITE A
ROGERSAR7275604/01/2023  
CHC00341-00Walmart Pharmacy 10-76112501 Perry Rd
PlainfieldIN4616807/01/2024  
CHC00341-00WESTERN PHARMACY GROUP LLCDBA COMMUNITY MEDICAL CENTER PHARMACY 610 GATEWAY CENTER WAY
SUITES A--E
SAN DIEGOCA9210210/01/2019 10/17/2022
History
SectionFieldActionActivityValue BeforeValue AfterTimestamp 
DetailsStateUpdate To Be TerminatedTerminated1/1/2025 12:01 AM
DatesLast Date That 340B Drugs PurchasedUpdateTermination Request 12/7/2024 12:00:00 AM12/6/2024 10:35 AM
DetailsStateUpdateTermination RequestActiveTo Be Terminated12/6/2024 10:35 AM
TerminationsTermination CommentsUpdateTermination Request We were given notice by the City of Chicago that the newly arrived shelter on Elston will be closing on 12/15/2024. 12/6/2024 10:35 AM
TerminationsTermination DateUpdateTermination Request 1/1/2025 12:00:00 AM12/6/2024 10:35 AM
TerminationsTermination Effective DateUpdateTermination Request 12/15/2024 12:00:00 AM12/6/2024 10:35 AM
TerminationsTermination ReasonUpdateTermination Request Site closure12/6/2024 10:35 AM
DetailsStateUpdate ApprovedActive10/1/2024 12:01 AM
ContactsPrimary ContactUpdatePC Change RequestDahbur, Alaina Finance & 340B Compliance Analyst PrimeCare Community Health, Inc. 7739888766Keisler, Kenzie Interim 340B Compliance Analyst PRIMECARE COMMUNITY HEALTH INC 80346520119/23/2024 7:45 AM
ContactsSigned ByInsertNew Registration Holtrop, Michael C Chief Financial Officer PrimeCare Community Health 61648298929/12/2024 11:33 AM
Details340B IDUpdateNew Registration CHC00341-099/12/2024 11:33 AM
DatesParticipating Approval DateUpdateNew Registration 9/12/2024 11:33:41 AM9/12/2024 11:33 AM
DetailsStateUpdateNew RegistrationPendingApproved9/12/2024 11:33 AM
DatesSigned By DateUpdateNew Registration 7/11/2024 12:42:10 PM9/12/2024 11:33 AM
DatesStart DateUpdateNew Registration 10/1/2024 12:00:00 AM9/12/2024 11:33 AM
AddressesMain AddressInsertNew Registration  1308 N Elston Ave Chicago, IL 60642-24167/8/2024 2:58 PM
ContactsAuthorizing OfficialInsertNew Registration Holtrop, Michael C Chief Financial Officer PrimeCare Community Health 61648298927/8/2024 2:58 PM
ContactsPrimary ContactInsertNew Registration Dahbur, Alaina Finance & 340B Compliance Analyst PrimeCare Community Health, Inc. 77398887667/8/2024 2:58 PM
DetailsAssistance Received From DateInsertNew Registration  7/8/2024 2:58 PM
DetailsAssistance Received To DateInsertNew Registration  7/8/2024 2:58 PM
DetailsLast Recertification DateInsertNew Registration  7/8/2024 2:58 PM
DetailsGrant NumberInsertNew Registration H80CS003417/8/2024 2:58 PM
Details340B IDInsertNew Registration  7/8/2024 2:58 PM
DetailsIs Authorizing Official EHB DataInsertNew Registration  7/8/2024 2:58 PM
DatesLast Date That 340B Drugs PurchasedInsertNew Registration  7/8/2024 2:58 PM
DetailsMedicare Provider NumberInsertNew Registration  7/8/2024 2:58 PM
DetailsEntity NameInsertNew Registration PRIMECARE COMMUNITY HEALTH INC7/8/2024 2:58 PM
DetailsNOFO NumberInsertNew Registration  7/8/2024 2:58 PM
DetailsProgram CodeInsertNew Registration CH7/8/2024 2:58 PM
DetailsEntity SubnameInsertNew Registration Elston7/8/2024 2:58 PM
DatesParticipating Approval DateInsertNew Registration  7/8/2024 2:58 PM
DetailsStateInsertNew Registration Pending7/8/2024 2:58 PM
DatesRegistration DateInsertNew Registration 7/8/2024 2:58:35 PM7/8/2024 2:58 PM
DatesSigned By DateInsertNew Registration  7/8/2024 2:58 PM
DatesStart DateInsertNew Registration  7/8/2024 2:58 PM
TerminationsTermination CommentsInsertNew Registration  7/8/2024 2:58 PM
TerminationsTermination DateInsertNew Registration  7/8/2024 2:58 PM
TerminationsTermination Effective DateInsertNew Registration  7/8/2024 2:58 PM
TerminationsTermination ReasonInsertNew Registration  7/8/2024 2:58 PM