Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
DSH140172 FRANCISCAN HEALTH OLYMPIA FIELDS

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

DBA: CVS/PHARMACY # 08949
15840 S. CICERO AVE.
OAK FOREST, IL 60452

Pharmacy Comments

Contract Details

Approval Date

4/11/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/31/2023
Pharmacy closed

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

340B Drug Pricing Program Database