Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
CHC24103-11 ESPERANZA HEALTH CENTERS

Covered Entity Details

Entity Name

ESPERANZA HEALTH CENTERS

Subdivision Name

Esperanza at Spry Community School

Type

HRSA-Funded Health Center

340B ID

CHC24103-11

Entity Address

2400 S Marshall Blvd RM 214
Chicago, IL 60623-4146

Grant Number

H80CS24103

Participating Start Date

10/1/2023

Last Recertification Date

Entity Termination Date

4/1/2024

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 17166
1940 W 33RD ST
CHICAGO, IL 60608

Pharmacy Comments

Contract Details

Approval Date

10/13/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Ryan Gadia, CFO
(773) 640-5792

Contract Pharmacy Representative

Montana CVS Pharmacy, LLC
Christian Reid, Senior Director
(401) 770-2118

Signed By Date

10/13/2023

340B Drug Pricing Program Database