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HIGHLAND PARK CVS, L.L.C.
CH051833A Heartland Community Health Clinic DBA: Heartland Health Services
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Covered Entity Details
Entity Name
Heartland Community Health Clinic DBA: Heartland Health Services
Subdivision Name
Garden
Type
HRSA-Funded Health Center
340B ID
CH051833A
Entity Address
1701 W Garden St
Peoria, IL 61605
Grant Number
H80CS02457
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
HIGHLAND PARK CVS, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 06455
1200 W. MAIN ST.
PEORIA, IL 61606
Pharmacy Comments
Contract Details
Approval Date
1/11/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
CHARLES BANDOIAN, CEO
(309) 680-7657
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
1/11/2018
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