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HIGHLAND PARK CVS, L.L.C.
CHC00341-03 PRIMECARE COMMUNITY HEALTH INC
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Covered Entity Details
Entity Name
PRIMECARE COMMUNITY HEALTH INC
Subdivision Name
PrimeCare Northwest
Type
HRSA-Funded Health Center
340B ID
CHC00341-03
Entity Address
1649 N Pulaski Rd
Chicago, IL 60639
Grant Number
H80CS00341
Participating Start Date
7/1/2013
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05681
3311 N. PULASKI RD.
CHICAGO, IL 60641
Pharmacy Comments
Contract Details
Approval Date
10/12/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/13/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Michael C Holtrop, Chief Financial Officer
(616) 482-9892
Contract Pharmacy Representative
Wellpartner
Bryn Wolgemuth, Account Manager
(917) 607-0428
Signed By Date
10/12/2023
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