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BRIDGEPORT PHARMACY
CH059300 FAMILY CHRISTIAN HEALTH CENTER
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Covered Entity Details
Entity Name
FAMILY CHRISTIAN HEALTH CENTER
Subdivision Name
FAMILY CHRISTIAN HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH059300
Entity Address
31 W 155th St
Harvey, IL 60426-3556
Grant Number
H80CS00879
Participating Start Date
4/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
BRIDGEPORT PHARMACY
Pharmacy Address
3201 S WALLACE
CHICAGO, IL 60616
Pharmacy Comments
Contract Details
Approval Date
10/15/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/25/2017
Agreement registered in error
Contacts
Covered Entity Signing Official
Lisa Green, CEO
(708) 339-5525
Contract Pharmacy Representative
Bienestar Pharmacy
Snejal Bhavsar, Senior Associate
(630) 452-3938
Signed By Date
10/15/2014
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