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DEITCH PHARMACY INC
CH05321B ERIE FAMILY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
ERIE FAMILY HEALTH CENTER, INC.
Subdivision Name
ERIE TEEN AND YOUNG ADULT HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH05321B
Entity Address
2418 W. Division Street
Chicago, IL 60622-2940
Grant Number
H80CS00115
Participating Start Date
1/1/1997
Last Recertification Date
2/16/2019
Entity Termination Date
10/1/2019
Pharmacy Details
Pharmacy Name
DEITCH PHARMACY INC
Pharmacy Address
1800 W CHICAGO AVE
CHICAGO, IL 60622
Pharmacy Comments
Contract Details
Approval Date
10/20/2010
Contract Begin Date
11/1/2010
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/22/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
10/19/2010
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