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KROGER PHARMACY
CH051833D Heartland Community Health Clinic DBA: Heartland Health Services
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Covered Entity Details
Entity Name
Heartland Community Health Clinic DBA: Heartland Health Services
Subdivision Name
Carver
Type
HRSA-Funded Health Center
340B ID
CH051833D
Entity Address
711 W. John H Gwynn Jr. Ave
Peoria, IL 61605
Grant Number
H80CS02457
Participating Start Date
7/1/2006
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
KROGER PHARMACY
Pharmacy Address
#863
2321 W. WISCONSIN
PEORIA, IL 61603
Pharmacy Comments
Contract Details
Approval Date
5/20/2010
Contract Begin Date
5/20/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/4/2018
Pharmacy closed
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
THOMAS CEBULKO, CONTROLLER
(317) 579-8334
Signed By Date
4/12/2010
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