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TONY'S MEDICENTER PHARMACY
RWI606162 Alliance Care 360
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Covered Entity Details
Entity Name
Alliance Care 360
Subdivision Name
Type
Ryan White Part A
340B ID
RWI606162
Entity Address
2929 S Wabash Avenue,
Suite
202
Chicago, IL 60616-3243
Grant Number
H89HA00008
Participating Start Date
7/1/2018
Last Recertification Date
2/3/2024
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
TONY'S MEDICENTER PHARMACY
Pharmacy Address
H&S PHARMACIES LLC
324 W BROADWAY
STEELEVILLE, IL 62288-1407
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ariq Cabbler, Director
(312) 808-1044 Ext: 101
Contract Pharmacy Representative
Medicine Shoppe #1633
Eric Schreiber, Owner
(417) 866-3054
Signed By Date
10/14/2019
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