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BIENESTAR PHARMACY
CH05662M ALIVIO MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
ALIVIO MEDICAL CENTER, INC
Subdivision Name
AMC Mobile Unit
Type
HRSA-Funded Health Center
340B ID
CH05662M
Entity Address
966 W 21st St
Chicago, IL 60608-4511
Grant Number
H80CS00116
Participating Start Date
1/1/2023
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
BIENESTAR PHARMACY
Pharmacy Address
BIENESTAR PHARMACY
966 W. 21ST ST
STE 104
CHICAGO, IL 60608
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ankit Prakash Patel, CFO
(312) 312-2719
Contract Pharmacy Representative
Bienestar Pharmacy
Snehal Bhavsar, Senior Associate
(630) 452-3938
Signed By Date
4/15/2024
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