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WISCONSIN CVS PHARMACY, L.L.C.
CH0511020 PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
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Covered Entity Details
Entity Name
PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
Subdivision Name
LISBON AVENUE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0511020
Entity Address
3522 W Lisbon Ave
Milwaukee, WI 53208-1953
Grant Number
H80CS00751
Participating Start Date
4/1/2008
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
WISCONSIN CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08767
2607 N. DOWNER AVE.
MILWAUKEE, WI 53211
Pharmacy Comments
Contract Details
Approval Date
7/10/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JENNI SEVENICH, CEO
(414) 934-9465
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/10/2019
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