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HIGHLAND PARK CVS, L.L.C.
CH058660D COMMUNITY HEALTHNET, INC
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Covered Entity Details
Entity Name
COMMUNITY HEALTHNET, INC
Subdivision Name
Community HealthNet OSC
Type
HRSA-Funded Health Center
340B ID
CH058660D
Entity Address
5927 Columbia Ave
Hammond, IN 46320-2611
Grant Number
H80CS06665
Participating Start Date
1/1/2018
Last Recertification Date
2/5/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05001
3033 N. BROADWAY ST.
CHICAGO, IL 60657
Pharmacy Comments
Contract Details
Approval Date
10/9/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
JANET SEABROOK, CEO
(219) 484-2442
Contract Pharmacy Representative
CVS Pharmacies
Christian Reid, 340B Program Director
(401) 770-2118
Signed By Date
10/9/2020
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