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HIGHLAND PARK CVS, L.L.C.
DSH140158 Insight Hospital and Medical Center Chicago
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Covered Entity Details
Entity Name
Insight Hospital and Medical Center Chicago
Subdivision Name
MAIN SITE
Type
Disproportionate Share Hospital
340B ID
DSH140158
Entity Address
2525 S. MICHIGAN AVENUE
CHICAGO, IL 60616
Medicare Provider Number
140158
Participating Start Date
7/1/2004
Last Recertification Date
8/14/2024
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 08515
1713 S ASHLAND
CHICAGO, IL 60608
Pharmacy Comments
Contract Details
Approval Date
4/11/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/17/2017
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Richard Cerceo, Chief Operating Officer
(312) 567-2583
Contract Pharmacy Representative
CVS Caremark
Anthony Gratto, 340B Vendor Manager
(401) 770-7298
Signed By Date
4/11/2014
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