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HIGHLAND PARK CVS, L.L.C.
CH05276Q CRUSADERS CENTRAL CLINIC ASSOCIATION
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Covered Entity Details
Entity Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Community Health on Alpine
Type
HRSA-Funded Health Center
340B ID
CH05276Q
Entity Address
1215 N ALPINE RD
ROCKFORD, IL 61107
Grant Number
H80CS00113
Participating Start Date
7/1/2017
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08530
6506 ALPINE RD.
LOVES PARK, IL 61111
Pharmacy Comments
Contract Details
Approval Date
1/13/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Samuel Miller, President/CEO
(815) 490-1600
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/13/2025
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