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KOMED HOLMAN PHARMACY
CH053280 NEAR NORTH HEALTH SERVICE CORPORATION, THE
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Covered Entity Details
Entity Name
NEAR NORTH HEALTH SERVICE CORPORATION, THE
Subdivision Name
WINFIELD MOODY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH053280
Entity Address
1276 N Clybourn Ave
Chicago, IL 60610-2089
Grant Number
H80CS00194
Participating Start Date
10/1/2007
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
KOMED HOLMAN PHARMACY
Pharmacy Address
AMERICAN PHARMACEUTICAL DRUGS INC
4259 S BERKELEY AVE
CHICAGO, IL 60653-3030
Pharmacy Comments
Contract Details
Approval Date
12/17/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
BERNEICE MILLS-THOMAS, EXECUTIVE DIRECTOR
(312) 337-1073 Ext: 200
Contract Pharmacy Representative
Snehal Bhavsar, Senior Associate
(773) 924-6000
Signed By Date
10/1/2012
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