Contract Pharmacy Details

LAWRENCE HOUSE DRUG CO.
RWI60607 MCDERMOTT CENTER

Covered Entity Details

Entity Name

MCDERMOTT CENTER

Subdivision Name

Type

Ryan White Part A

340B ID

RWI60607

Entity Address

932 W WASHINGTON ST
CHICAGO, IL 60607

Grant Number

H89HA00008

Participating Start Date

1/1/2019

Last Recertification Date

2/7/2020

Entity Termination Date

4/1/2021

Pharmacy Details

Pharmacy Name

LAWRENCE HOUSE DRUG CO.

Pharmacy Address

1026 W. LAWRENCE AVE.
CHICAGO, IL 60640

Pharmacy Comments

Contract Details

Approval Date

11/23/2018

Contract Begin Date

1/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

James C Baldwin, CFO
(312) 226-7984 Ext: 449

Contract Pharmacy Representative

LAWRENCE HOUSE
JOSEPH ROGOWIN, PHARMACIST
(773) 561-2288

Signed By Date

10/15/2018