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HIGHLAND PARK CVS, L.L.C.
CH05276B CRUSADERS CENTRAL CLINIC ASSOCIATION
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Covered Entity Details
Entity Name
CRUSADERS CENTRAL CLINIC ASSOCIATION
Subdivision Name
Crusader Clinic on Broadway
Type
HRSA-Funded Health Center
340B ID
CH05276B
Entity Address
1100 Broadway
Rockford, IL 61104-1429
Grant Number
H80CS00113
Participating Start Date
7/1/1997
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08531
110 S. ALPINE RD.
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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