Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
CH05642AN LAWNDALE CHRISTIAN HEALTH CENTER

Covered Entity Details

Entity Name

LAWNDALE CHRISTIAN HEALTH CENTER

Subdivision Name

Temporary Site - Lawndale Christian Health

Type

HRSA-Funded Health Center

340B ID

CH05642AN

Entity Address

526 N Western Ave RM 1
Chicago, IL 60623-1422

Grant Number

H80CS00725

Participating Start Date

10/1/2024

Last Recertification Date

Entity Termination Date

1/1/2025

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 04793
1211 W. ROOSEVELT RD.
CHICAGO, IL 60608

Pharmacy Comments

Contract Details

Approval Date

10/15/2024

Contract Begin Date

1/1/2025

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

10/15/2024

340B Drug Pricing Program Database