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ROSELAND COMMUNITY HOSPITAL ASSOCIATION
FP604668 AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
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Covered Entity Details
Entity Name
AUNT MARTHA'S YOUTH SERVICE CENTER, INC.
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP604668
Entity Address
233 WEST JOE ORR ROAD
CHICAGO HEIGHTS, IL 60411
Grant Number
FPHPA056060
Participating Start Date
1/1/1998
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
ROSELAND COMMUNITY HOSPITAL ASSOCIATION
Pharmacy Address
DBA THE NEW ROSELAND OUTPATIENT PHARMACY
45 W 111TH ST
CHICAGO, IL 60628-4200
Pharmacy Comments
Contract Details
Approval Date
4/15/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Audrey Pennington, Chief Operating Officer
(708) 747-7100
Contract Pharmacy Representative
PAMELA TANYITIKU, Director of Pharmacy
(773) 995-4841
Signed By Date
4/15/2017
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