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MIDWEST PHARMACIES INC
CH057440 PCC COMMUNITY WELLNESS CENTER
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Covered Entity Details
Entity Name
PCC COMMUNITY WELLNESS CENTER
Subdivision Name
PCC Lake Street Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH057440
Entity Address
14 Lake St
Oak Park, IL 60302-2606
Grant Number
H80CS00276
Participating Start Date
7/1/1997
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
MIDWEST PHARMACIES INC
Pharmacy Address
DBA PLAZA PHARMACY
1 ERIE CT
OAK PARK, IL 60302-2566
Pharmacy Comments
Contract Details
Approval Date
1/15/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/5/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Robert Urso, President & CEO
(708) 524-7686
Contract Pharmacy Representative
West Suburban Medical Center
Ann E. Montgomery, Director of Pharmacy
(708) 763-1398
Signed By Date
1/15/2019
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