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DELIVERCARERX PHARMACY LLC
CH0518280 Stacy McKay Health & Education Center
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Covered Entity Details
Entity Name
Stacy McKay Health & Education Center
Subdivision Name
Type
HRSA-Funded Health Center
340B ID
CH0518280
Entity Address
6450 US HWY 6
PORTAGE, IN 46368
Grant Number
H80CS02458
Participating Start Date
1/1/2004
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
DELIVERCARERX PHARMACY LLC
Pharmacy Address
DELIVERCARERX PHARMACY LLC
1471 E BUSINESS CENTER DR
STE 200
MT PROSPECT, IL 60056
Pharmacy Comments
Contract Details
Approval Date
8/1/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/25/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JANICE WILSON, CEO
(219) 764-6052
Contract Pharmacy Representative
Agape
Dave Krishna, CEO
(847) 965-1600
Signed By Date
8/1/2017
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