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PETERSON PHARMACY INC
CH051827B ASIAN HUMAN SERVICES FAMILY HEALTH CENTER
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Covered Entity Details
Entity Name
ASIAN HUMAN SERVICES FAMILY HEALTH CENTER
Subdivision Name
AHS Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH051827B
Entity Address
2501 W Peterson Ave
Chicago, IL 60659-4108
Grant Number
H80CS02327
Participating Start Date
1/1/2014
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PETERSON PHARMACY INC
Pharmacy Address
2517 W PETERSON AVE
CHICAGO, IL 60659
Pharmacy Comments
Contract Details
Approval Date
4/5/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/16/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Muhammad W. Paracha, CEO
(773) 761-0300 Ext: 2409
Contract Pharmacy Representative
Altamash Khan, CEO
(773) 275-6300
Signed By Date
4/5/2017
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