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HIGHLAND PARK CVS, L.L.C.
RRC140281-00 NORTHWESTERN MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NORTHWESTERN MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140281-00
Entity Address
251 E HURON
CHICAGO, IL 60611
Medicare Provider Number
140281
Participating Start Date
8/7/2020
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 02942
401 W. ARMITAGE AVE.
CHICAGO, IL 60614
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
7/26/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/23/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Francis Donald Fraher, CFO
(312) 926-5236
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/15/2022
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