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HAYAT PHARMACY 19
CH0511020 PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
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Covered Entity Details
Entity Name
PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
Subdivision Name
LISBON AVENUE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH0511020
Entity Address
3522 W Lisbon Ave
Milwaukee, WI 53208-1953
Grant Number
H80CS00751
Participating Start Date
4/1/2008
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HAYAT PHARMACY 19
Pharmacy Address
805 W LAYTON AVE STE A
MILWAUKEE, WI 53221-2426
Pharmacy Comments
Contract Details
Approval Date
4/11/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Candice Cole, Chief Executive Officer
(414) 882-2030
Contract Pharmacy Representative
Hayat Pharmacy
Hashim Zaibak, CEO
(414) 712-5200
Signed By Date
4/11/2024
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