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HAYAT PHARMACY 20 LLC.
CH051102E PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
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Covered Entity Details
Entity Name
PROGRESSIVE COMMUNITY HEALTH CENTERS, INC
Subdivision Name
12th Street Urgent Care
Type
HRSA-Funded Health Center
340B ID
CH051102E
Entity Address
945 N 12TH ST
MILWAUKEE, WI 53233-1305
Grant Number
H80CS00751
Participating Start Date
10/1/2016
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HAYAT PHARMACY 20 LLC.
Pharmacy Address
807 W LAYTON AVE STE B
MILWAUKEE, WI 53221
Pharmacy Comments
Contract Details
Approval Date
7/15/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Candice Cole, Chief Executive Officer
(414) 882-2030
Contract Pharmacy Representative
Hayat Pharmacy
Hashim Zaibak, CEO
(414) 712-5200
Signed By Date
7/15/2024
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