Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
CH057260D KENOSHA COMMUNITY HEALTH CENTER, INC.

Covered Entity Details

Entity Name

KENOSHA COMMUNITY HEALTH CENTER, INC.

Subdivision Name

Kenosha Community Health Center Mobile Medical Unit

Type

HRSA-Funded Health Center

340B ID

CH057260D

Entity Address

6226 14th Ave
Kenosha, WI 53143-4413

Grant Number

H80CS00662

Participating Start Date

4/1/2023

Last Recertification Date

2/15/2024

Entity Termination Date

10/1/2024

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

CVS PHARMACY # 16350
6150 W TOUHY AVE
NILES, IL 60714

Pharmacy Comments

Contract Details

Approval Date

10/16/2023

Contract Begin Date

1/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/16/2023
Agreement registered in error

Contacts

Covered Entity Signing Official

Gary Moss, Chief Financial Officer
(262) 764-3619

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

10/16/2023

340B Drug Pricing Program Database