Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
CH05642S LAWNDALE CHRISTIAN HEALTH CENTER

Covered Entity Details

Entity Name

LAWNDALE CHRISTIAN HEALTH CENTER

Subdivision Name

LCHC Belle Whaley

Type

HRSA-Funded Health Center

340B ID

CH05642S

Entity Address

3812 W. Ogden Ave
CHICAGO, IL 60623-2458

Grant Number

H80CS00725

Participating Start Date

4/1/2019

Last Recertification Date

1/31/2024

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 02844
6748 ROOSEVELT RD.
OAK PARK, IL 60304

Pharmacy Comments

Contract Details

Approval Date

7/2/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2025
Covered Entity Terminated

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

340B Drug Pricing Program Database