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HIGHLAND PARK CVS, L.L.C.
RRC140281-00 NORTHWESTERN MEMORIAL HOSPITAL
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Covered Entity Details
Entity Name
NORTHWESTERN MEMORIAL HOSPITAL
Subdivision Name
Type
Rural Referral Center
340B ID
RRC140281-00
Entity Address
251 E HURON
CHICAGO, IL 60611
Medicare Provider Number
140281
Participating Start Date
8/7/2020
Last Recertification Date
8/27/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 17437
4466 N BROADWAY ST
CHICAGO, IL 60640
Pharmacy Comments
Contract Details
Approval Date
1/12/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Matthew Joseph Flynn, VP, Finance, NMHC
(312) 926-5236
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/12/2024
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