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HIGHLAND PARK CVS, L.L.C.
CH05321C ERIE FAMILY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
ERIE FAMILY HEALTH CENTER, INC.
Subdivision Name
Erie Humboldt Park Health Center
Type
HRSA-Funded Health Center
340B ID
CH05321C
Entity Address
2750 W North Ave
Chicago, IL 60647
Grant Number
H80CS00115
Participating Start Date
1/1/1997
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 05482
3615 N. CENTRAL AVE
CHICAGO, IL 60634
Pharmacy Comments
Contract Details
Approval Date
7/12/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
David Bruce, Chief Financial & Administrative Officer (CFAO)
(312) 432-2725
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
7/12/2024
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