Contract Pharmacy Details

HIGHLAND PARK CVS, L.L.C.
CH051030 TCA HEALTH, INC. NFP

Covered Entity Details

Entity Name

TCA HEALTH, INC. NFP

Subdivision Name

THE CLINIC IN ALTGELD, INC.

Type

HRSA-Funded Health Center

340B ID

CH051030

Entity Address

1029 E 130th St
Chicago, IL 60628-6908

Grant Number

H80CS00109

Participating Start Date

10/1/1997

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

HIGHLAND PARK CVS, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 07327
600-618 E. SIBLEY BLVD.
DOLTON, IL 60419

Pharmacy Comments

Contract Details

Approval Date

4/1/2006

Contract Begin Date

4/1/2006

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

2/16/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

Signed By Date

3/7/2006

340B Drug Pricing Program Database