Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
CH05103B TCA HEALTH, INC. NFP

Covered Entity Details

Entity Name

TCA HEALTH, INC. NFP

Subdivision Name

Mobile Student Health Clinic, Parking Lot B

Type

HRSA-Funded Health Center

340B ID

CH05103B

Entity Address

1029 East 130th St., Pkg Lot B
Chicago, IL 60628-6062

Grant Number

H80CS00109

Participating Start Date

4/1/2020

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07166
250 W. 144TH ST.
RIVERDALE, IL 60827

Pharmacy Comments

Contract Details

Approval Date

4/14/2023

Contract Begin Date

7/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

VERONICA CLARKE, CEO
(773) 995-6300 Ext: 213

Contract Pharmacy Representative

CVS Health
Christine Reid, Executive Director 340B
(904) 271-5532

Signed By Date

4/14/2023

340B Drug Pricing Program Database