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BIENESTAR PHARMACY
CH056620 ALIVIO MEDICAL CENTER, INC
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Covered Entity Details
Entity Name
ALIVIO MEDICAL CENTER, INC
Subdivision Name
ALIVIO MEDICAL CENTER
Type
HRSA-Funded Health Center
340B ID
CH056620
Entity Address
2355 S. WESTERN AVE
CHICAGO, IL 60608-3837
Grant Number
H80CS00116
Participating Start Date
7/1/1998
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
BIENESTAR PHARMACY
Pharmacy Address
BIENESTAR PHARMACY
966 W. 21ST ST
STE 104
CHICAGO, IL 60608
Pharmacy Comments
Contract Details
Approval Date
7/3/2006
Contract Begin Date
7/3/2006
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Signed By Date
6/30/2006
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