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AMIJAY CORPORATION
CH05190A Heartland Alliance Health, INC.
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Covered Entity Details
Entity Name
Heartland Alliance Health, INC.
Subdivision Name
Heartland Alliance Health James West Clinic
Type
HRSA-Funded Health Center
340B ID
CH05190A
Entity Address
932 W WASHINGTON BLVD
STE 224
Chicago, IL 60607-2217
Grant Number
H80CS00111
Participating Start Date
4/1/2014
Last Recertification Date
1/29/2024
Entity Termination Date
1/1/2025
Pharmacy Details
Pharmacy Name
AMIJAY CORPORATION
Pharmacy Address
3441 W NORTH AVE
DBA LAPUJA PHARMACY
CHICAGO, IL 60647-4841
Pharmacy Comments
Contract Details
Approval Date
1/21/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/29/2016
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
karen Batia, Executive Director
(773) 751-4104
Contract Pharmacy Representative
Mukeesh Patel, Owner
(773) 772-6731
Signed By Date
1/21/2015
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