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SOUTH WABASH CVS, L.L.C.
CHC26565-01 Hamdard Health Alliance
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Covered Entity Details
Entity Name
Hamdard Health Alliance
Subdivision Name
Hamdard Health Rogers Park
Type
HRSA-Funded Health Center
340B ID
CHC26565-01
Entity Address
1542 W Devon Ave
Chicago, IL 60660-1344
Grant Number
H80CS26565
Participating Start Date
4/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
SOUTH WABASH CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 03674
105 S. WABASH AVE.
CHICAGO, IL 60603
Pharmacy Comments
Contract Details
Approval Date
10/15/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/11/2022
Pharmacy closed
Contacts
Covered Entity Signing Official
Kiran S. Siddique, COO
(773) 465-4600 Ext: 227
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/15/2021
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