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DEVON DISCOUNT PHARMACY
CHC26565-01 Hamdard Health Alliance
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Covered Entity Details
Entity Name
Hamdard Health Alliance
Subdivision Name
Hamdard Health Rogers Park
Type
HRSA-Funded Health Center
340B ID
CHC26565-01
Entity Address
1542 W Devon Ave
Chicago, IL 60660-1344
Grant Number
H80CS26565
Participating Start Date
4/1/2014
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
DEVON DISCOUNT PHARMACY
Pharmacy Address
1542 W. DEVON AVE.
CHICAGO, IL 60660-1344
Pharmacy Comments
Contract Details
Approval Date
4/7/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kiran S. Siddique, COO
(773) 465-4600 Ext: 227
Contract Pharmacy Representative
Andreas Iskos, Pharmacist in Charge
(773) 465-8688
Signed By Date
4/7/2014
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