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ROSELAND COMMUNITY HOSPITAL ASSOCIATION
CH05972AB AUNT MARTHA'S HEALTH & WELLNESS, INC.
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Covered Entity Details
Entity Name
AUNT MARTHA'S HEALTH & WELLNESS, INC.
Subdivision Name
Great River Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH05972AB
Entity Address
120 E Court St
Toulon, IL 61483-5388
Grant Number
H80CS00685
Participating Start Date
7/1/2014
Last Recertification Date
2/25/2022
Entity Termination Date
4/1/2023
Pharmacy Details
Pharmacy Name
ROSELAND COMMUNITY HOSPITAL ASSOCIATION
Pharmacy Address
DBA THE NEW ROSELAND OUTPATIENT PHARMACY
45 W 111TH ST
CHICAGO, IL 60628-4200
Pharmacy Comments
Contract Details
Approval Date
4/15/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Audrey Pennington, Chief Operating Officer
(708) 747-7100
Contract Pharmacy Representative
PAMELA TANYITIKU, Director of Pharmacy
(773) 995-4841
Signed By Date
4/15/2017
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