Contract Pharmacy Details

LIFECARE PHARMACY
CHC26565-00 Hamdard Health Alliance

Covered Entity Details

Entity Name

Hamdard Health Alliance

Subdivision Name

Hamdard Health Addison

Type

HRSA-Funded Health Center

340B ID

CHC26565-00

Entity Address

228 E Lake St
Addison, IL 60101-2889

Grant Number

H80CS26565

Participating Start Date

4/1/2014

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

LIFECARE PHARMACY

Pharmacy Address

276 W FULLERTON AVE
ADDISON, IL 60101

Pharmacy Comments

Contract Details

Approval Date

7/1/2016

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
(630) 543-1000

Signed By Date

7/1/2016