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HIGHLAND PARK CVS, L.L.C.
CH05276T CRUSADERS CENTRAL CLINIC ASSOCIATION
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Covered Entity Details
Entity Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Rosecrance Ware Center
Type
HRSA-Funded Health Center
340B ID
CH05276T
Entity Address
2704 N. Main Street
Rockford, IL 61103
Grant Number
H80CS00113
Participating Start Date
10/1/2023
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
CVS PHARMACY # 16258
6560 E STATE ST
ROCKFORD, IL 61108
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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