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HIGHLAND PARK CVS, L.L.C.
CH056420 LAWNDALE CHRISTIAN HEALTH CENTER
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Covered Entity Details
Entity Name
LAWNDALE CHRISTIAN HEALTH CENTER
Subdivision Name
Lawndale Christian Health Center Main Clinic
Type
HRSA-Funded Health Center
340B ID
CH056420
Entity Address
3860 W Ogden Ave
Chicago, IL 60623-2460
Grant Number
H80CS00725
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 # 02664
11 E 14TH ST.,
CHICAGO HEIGHTS, IL 60411
Pharmacy Comments
Contract Details
Approval Date
4/9/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/15/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Alyssa Sianghio, Chief Administrative Officer (CAO)
(872) 588-3015
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/9/2020
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