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HIGHLAND PARK CVS, L.L.C.
DSH140172 FRANCISCAN HEALTH OLYMPIA FIELDS
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Covered Entity Details
Entity Name
FRANCISCAN HEALTH OLYMPIA FIELDS
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH140172
Entity Address
20201 SOUTH CRAWFORD AVE
OLYMPIA FIELDS, IL 60461
Medicare Provider Number
140172
Participating Start Date
4/1/2015
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16306
5071 CAL SAG RD
CRESTWOOD, IL 60418-1458
Pharmacy Comments
Contract Details
Approval Date
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Frank J McHugh, VP Finance - CFO
(708) 747-4000 Ext: 82014
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
4/11/2023
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