Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
CH056420 LAWNDALE CHRISTIAN HEALTH CENTER

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 # 04487
8625 S. HARLEM AVE.
BRIDGEVIEW, IL 60455

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

6/29/2022
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

340B Drug Pricing Program Database