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WAL-MART PHARMACY 10-1938
CH05662L ALIVIO MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
ALIVIO MEDICAL CENTER, INC
Subdivision Name
Alivio's Walk In Wellness Center at Berwyn
Type
HRSA-Funded Health Center
340B ID
CH05662L
Entity Address
6447 West Cermak Road, Suite 100
Berwyn, IL 60402
Grant Number
H80CS00116
Participating Start Date
1/1/2023
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
WAL-MART PHARMACY 10-1938
Pharmacy Address
7050 SOUTH CICERO AVENUE
BEDFORD PARK, IL 60638
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
Wal-Mart
Marcus Osbourne, Vice President
(800) 939-2022
Signed By Date
4/15/2024
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