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PRIME PLUS LAKEVIEW INC
CH051278H Tapestry 360 Health
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Covered Entity Details
Entity Name
Tapestry 360 Health
Subdivision Name
Tapestry 360 Health - LAKEVIEW
Type
HRSA-Funded Health Center
340B ID
CH051278H
Entity Address
3154 N Clark St
CHICAGO, IL 60657
Grant Number
H80CS00215
Participating Start Date
4/1/2010
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
PRIME PLUS LAKEVIEW INC
Pharmacy Address
3156 N CLARK ST
CHICAGO, IL 60657
Pharmacy Comments
Contract Details
Approval Date
7/5/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Nicole Willis, CEO
(773) 296-7589
Contract Pharmacy Representative
PHARMACY ONE
Ray Dahabra, Manager
(773) 267-5050
Signed By Date
7/5/2024
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