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

CVS PHARMACY # 17009
1154 S CLARK ST
CHICAGO, IL 60605

Pharmacy Comments

Contract Details

Approval Date

1/12/2021

Contract Begin Date

4/1/2021

Carve-In Effective Date

Contract Comments

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

1/12/2021

340B Drug Pricing Program Database