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HIGHLAND PARK CVS, L.L.C.
CH053150 COMMUNITY HEALTH IMPROVEMENT CENTER
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Covered Entity Details
Entity Name
COMMUNITY HEALTH IMPROVEMENT CENTER
Subdivision Name
COMMUNITY HEALTH IMPROVEMENT CENTER
Type
HRSA-Funded Health Center
340B ID
CH053150
Entity Address
320 East Central Avenue
Decatur, IL 62521-4665
Grant Number
H80CS00681
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04857
570 N. FAIRVIEW AVE.
DECATUR, IL 62522
Pharmacy Comments
Contract Details
Approval Date
1/14/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tanya Renee Andricks, CEO
(217) 877-6111
Contract Pharmacy Representative
CVS
Christian Reid, Director
(401) 770-2118
Signed By Date
1/14/2020
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