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WAL-MART PHARMACY 10-5646
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
WAL-MART PHARMACY 10-5646
Pharmacy Address
2551 W CERMAK
CHICAGO, IL 60608
Pharmacy Comments
Contract Details
Approval Date
4/15/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/15/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Sandra I. Flores, Director of Development
(312) 829-6370
Contract Pharmacy Representative
Wal-Mart
Marcus Osbourne, VP of Health and Wellness Transformation
(479) 204-9374
Signed By Date
4/15/2016
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