Contract Pharmacy Details

UNIVERSITY OF ILLINOIS MILE SQUARE PHARM
CH057580 University of Illinois

Covered Entity Details

Entity Name

University of Illinois

Subdivision Name

University of Illinois Mile Square Health Center - IMD

Type

HRSA-Funded Health Center

340B ID

CH057580

Entity Address

1220 S. Wood Street
Chicago, IL 60608

Grant Number

H80CS00324

Participating Start Date

1/1/2000

Last Recertification Date

2/23/2025

Pharmacy Details

Pharmacy Name

UNIVERSITY OF ILLINOIS MILE SQUARE PHARM

Pharmacy Address

1220 S WOOD ST STE 1045
CHICAGO, IL 60608

Pharmacy Comments

Contract Details

Approval Date

8/21/2007

Contract Begin Date

8/21/2007

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Rhondi Inman, Assistant Director
(312) 413-1767

Contract Pharmacy Representative

University of Illinois Mile Square
Rhondi Inman, Assistant Director
(312) 413-1767

Signed By Date

8/21/2007

340B Drug Pricing Program Database