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HIGHLAND PARK CVS, L.L.C.
CH05642D LAWNDALE CHRISTIAN HEALTH CENTER
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Covered Entity Details
Entity Name
LAWNDALE CHRISTIAN HEALTH CENTER
Subdivision Name
LCHC at Habilitative Systems
Type
HRSA-Funded Health Center
340B ID
CH05642D
Entity Address
415 S Kilpatrick Ave
Chicago, IL 60644
Grant Number
H80CS00725
Participating Start Date
10/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04979
7855 S. WESTERN AVE.
CHICAGO, IL 60620
Pharmacy Comments
Contract Details
Approval Date
1/6/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
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
1/6/2025
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