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PHARMBLUE ILLINOIS LLC
RWII60435 Agape Missions, NFP
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Covered Entity Details
Entity Name
Agape Missions, NFP
Subdivision Name
Type
Ryan White Part B
340B ID
RWII60435
Entity Address
840 Plainfield Road
Joliet, IL 60435
Grant Number
X07HA00013
Participating Start Date
1/1/2020
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE ILLINOIS LLC
Pharmacy Address
2960 CHARTRES ST
SUITE 100
LA SALLE, IL 61301-1097
Pharmacy Comments
Contract Details
Approval Date
12/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jill Ann Skole, CEO
(815) 723-1548 Ext: 201
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
10/1/2019
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