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PRXP OF CA LLC
CH05930A FAMILY CHRISTIAN HEALTH CENTER
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Covered Entity Details
Entity Name
FAMILY CHRISTIAN HEALTH CENTER
Subdivision Name
Family Christian Health Center
Type
HRSA-Funded Health Center
340B ID
CH05930A
Entity Address
713 E. 142nd St.
Dolton, IL 60419-1062
Grant Number
H80CS00879
Participating Start Date
10/1/2014
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
PRXP OF CA LLC
Pharmacy Address
PRXP OF CA LLC
4345 E LOWELL ST
STE C & D
ONTARIO, CA 91761
Pharmacy Comments
Contract Details
Approval Date
7/16/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/13/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Lisa Green, CEO
(708) 339-5525
Contract Pharmacy Representative
Physicians Rx Pharmacy of Clinton
Chris Wakefield, Manager
(412) 357-5163
Signed By Date
7/16/2019
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