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XPRESS PHARMACY INC
CHC33649-03 Inner City Muslim Action Network
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Covered Entity Details
Entity Name
Inner City Muslim Action Network
Subdivision Name
IMAN Mobile Health Unit
Type
HRSA-Funded Health Center
340B ID
CHC33649-03
Entity Address
2744 W 63rd St
Chicago, IL 60629-2343
Grant Number
H80CS33649
Participating Start Date
4/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
XPRESS PHARMACY INC
Pharmacy Address
6700 W 95TH ST STE 150
OAK LAWN, IL 60453-6045
Pharmacy Comments
Contract Details
Approval Date
1/20/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sofia Adawy, Senior Health Center Director
(773) 434-4626
Contract Pharmacy Representative
Inner-city Muslim Action Network
Maysoon Haleem, Director of Revenue Cycle
(773) 464-4626
Signed By Date
1/16/2023
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