Contract Pharmacy Details

PETERSON PHARMACY INC
CHC26565-01 Hamdard Health Alliance

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

PETERSON PHARMACY INC

Pharmacy Address

2517 W PETERSON AVE
CHICAGO, IL 60659

Pharmacy Comments

Contract Details

Approval Date

7/8/2016

Contract Begin Date

10/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

9/25/2017
Agreement registered in error

Contacts

Covered Entity Signing Official

Kiran S. Siddique, COO
(773) 465-4600 Ext: 227

Contract Pharmacy Representative

Altamash Khan, CEO
(773) 275-6300

Signed By Date

7/8/2016