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HIGHLAND PARK CVS, L.L.C.
FQHCLA402 Good Samaritan Family Health Center Inc.
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Covered Entity Details
Entity Name
Good Samaritan Family Health Center Inc.
Subdivision Name
Family Health Center
Type
Health Center Program Look-Alike
340B ID
FQHCLA402
Entity Address
1027 Washington Avenue
Suite B
Vincennes, IN 47591
Grant Number
LALCS33817
Participating Start Date
1/1/2020
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06386
1421 STATE ST.
LAWRENCEVILLE, IL 62439
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Emmons, CEO
(812) 494-7500
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/13/2020
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