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WAL-MART PHARMACY 10-1553
CHC26565-00 Hamdard Health Alliance
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Covered Entity Details
Entity Name
Hamdard Health Alliance
Subdivision Name
Hamdard Health Addison
Type
HRSA-Funded Health Center
340B ID
CHC26565-00
Entity Address
228 E Lake St
Addison, IL 60101-2889
Grant Number
H80CS26565
Participating Start Date
4/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1553
Pharmacy Address
314 WEST ARMY TRAIL RD
BLOOMINGDALE, IL 60108
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kiran S. Siddique, COO
(773) 465-4600 Ext: 227
Contract Pharmacy Representative
Caremark LLC
Christina Reddi, Account Manager
(347) 380-3546
Signed By Date
10/14/2022
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