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HIGHLAND PARK CVS, L.L.C.
CH05642AG LAWNDALE CHRISTIAN HEALTH CENTER
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Covered Entity Details
Entity Name
LAWNDALE CHRISTIAN HEALTH CENTER
Subdivision Name
LCHC at Bobby E. Wright
Type
HRSA-Funded Health Center
340B ID
CH05642AG
Entity Address
5002 W Madison St
Chicago, IL 60644-4127
Grant Number
H80CS00725
Participating Start Date
4/1/2024
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 01493
5205 N. BROADWAY ST.
CHICAGO, IL 60640
Pharmacy Comments
Contract Details
Approval Date
7/2/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Robert Dons, Chief Financial Officer
(872) 588-3032
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/2/2024
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