Contract Pharmacy Details

PHARMACY ONE PLUS
CH051278J Tapestry 360 Health

Covered Entity Details

Entity Name

Tapestry 360 Health

Subdivision Name

Tapestry 360 Health - Hibbard

Type

HRSA-Funded Health Center

340B ID

CH051278J

Entity Address

3244 W Ainslie St
Chicago, IL 60625-5018

Grant Number

H80CS00215

Participating Start Date

10/1/2010

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

PHARMACY ONE PLUS

Pharmacy Address

THURAYA, INC
4753-55 N KEDZIE AVE
CHICAGO, IL 60625

Pharmacy Comments

Contract Details

Approval Date

1/26/2018

Contract Begin Date

4/1/2018

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Gwenn Rausch, CEO
(773) 296-7587

Contract Pharmacy Representative

PHARMACY ONE
Ray Dahabra, Manager
(773) 267-5050

Signed By Date

1/26/2018