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CH05758N UNIVERSITY OF ILLINOIS (Terminated)
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Main Details
Name
UNIVERSITY OF ILLINOIS
Subdivision Name
UNIVERSITY OF ILLINOIS MILE SQUARE HEALTH CENTER - HUMBOLDT PARK
Type
HRSA-Funded Health Center
Site ID
BPS-H80-013800
340B ID
CH05758N
Grant Number
H80CS00324
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2015
Participating Start Date
4/1/2015
Participating Approval Date
1/20/2015
Last Recertification Date
2/14/2023
Termination Date
Termination Reason
1/1/2024
Site closure
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
Kimary Lee, Senior Director Compliance and Development
(312) 413-0278
Addresses
Street Address
3240 W DIVISION ST
CHICAGO, IL 60651-2405
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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April 2025
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