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BIENESTAR PHARMACY
CH05662F ALIVIO MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
ALIVIO MEDICAL CENTER, INC
Subdivision Name
Jose Clemente Orozco Academy
Type
HRSA-Funded Health Center
340B ID
CH05662F
Entity Address
1940 W 18th St
Chicago, IL 60608-1903
Grant Number
H80CS00116
Participating Start Date
7/1/2013
Last Recertification Date
2/26/2025
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
4/16/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
ESTHER CORPUZ, CHIEF EXECUTIVE OFFICER
(312) 829-6304
Contract Pharmacy Representative
Bienestar Pharmacy
Akil Ghoghawala, Partner
(312) 226-2266
Signed By Date
4/16/2024
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