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WAL-MART PHARMACY 10-1737
CHC26565-02 Hamdard Health Alliance
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Covered Entity Details
Entity Name
Hamdard Health Alliance
Subdivision Name
Hamdard Health Bensenville
Type
HRSA-Funded Health Center
340B ID
CHC26565-02
Entity Address
1240 Il Route 83
Bensenville, IL 60106-1034
Grant Number
H80CS26565
Participating Start Date
10/1/2021
Last Recertification Date
2/6/2024
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1737
Pharmacy Address
900 SOUTH ROUTE 83
VILLA PARK, IL 60181
Pharmacy Comments
Contract Details
Approval Date
10/14/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
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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