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CH05758L University of Illinois (Active)
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Main Details
Name
University of Illinois
Subdivision Name
Mile Square Health Center at Cicero
Type
HRSA-Funded Health Center
Site ID
BPS-H80-008724
340B ID
CH05758L
Grant Number
H80CS00324
Additional Details
Current Program Status
Active
Registration Date
10/12/2012
Participating Start Date
1/1/2013
Participating Approval Date
10/22/2012
Last Recertification Date
2/23/2025
Contacts
Authorizing Official
University of Illinois at Chicago
Michael Moss, Associate Vice Chancellor, Budget & Financial Analysis
(312) 996-0306
Primary Contact
UI Health Mile Square Health Center
Phyllis Grice, Chief Operating Officer
(312) 413-0728
Addresses
Street Address
4747-51 West Cermak Road
Cicero, IL 60804-2508
Billing Address
University of Illinois
Invoice Processing Center
PO Box 820
Rantoul, IL 61866
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Grantee Sites
Grantee Sites Contract Pharmacies
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10/22/12 - Reviewed registration and forwarded to IS for approval.
10/22/2012
April 2025
April 2025
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