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PHARMBLUE ILLINOIS LLC
HV60120 OPEN DOOR CLINIC OF GREATER ELGIN
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Covered Entity Details
Entity Name
OPEN DOOR CLINIC OF GREATER ELGIN
Subdivision Name
Type
Ryan White Part C
340B ID
HV60120
Entity Address
1665 Larkin Ave
ELGIN, IL 60123
Grant Number
H76HA01704
Participating Start Date
10/1/2004
Last Recertification Date
2/28/2022
Entity Termination Date
4/1/2023
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
4/13/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Perry Maier, Asst. Director
(847) 695-1093
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
4/13/2016
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