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HAYAT PHARMACY 6
CH05306AT Sixteenth Street Community Health Centers, Inc.
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Covered Entity Details
Entity Name
Sixteenth Street Community Health Centers, Inc.
Subdivision Name
Sixteenth Street Community Health Centers-Layton
Type
HRSA-Funded Health Center
340B ID
CH05306AT
Entity Address
4570 S 27th St
Milwaukee, WI 53221-2145
Grant Number
H80CS00593
Participating Start Date
7/1/2018
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HAYAT PHARMACY 6
Pharmacy Address
HAYAT PHARMACY 6
4931 S 27TH ST STE 400
GREENFIELD, WI 53221-2653
Pharmacy Comments
Contract Details
Approval Date
7/12/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Liz Claudio, Vice President, Operations
(414) 897-5165
Contract Pharmacy Representative
Hayat Pharmacy
Tamir Kaloti, President
(262) 893-2100
Signed By Date
7/12/2022
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