Contract Pharmacy Details

BIENESTAR PHARMACY
CH05662J ALIVIO MEDICAL CENTER, INC

Covered Entity Details

Entity Name

ALIVIO MEDICAL CENTER, INC

Subdivision Name

Benito Juarez Community Academy

Type

HRSA-Funded Health Center

340B ID

CH05662J

Entity Address

1450 W Cermak Rd
Chicago, IL 60608-4408

Grant Number

H80CS00116

Participating Start Date

7/1/2015

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

4/17/2024

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
Snehal Bhavsar, Senior Associate
(630) 452-3938

Signed By Date

4/17/2024

340B Drug Pricing Program Database