Contract Pharmacy Details

WALGREEN CO
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

WALGREEN CO

Pharmacy Address

DBA; WALGREENS #12583
1704 E. RIVERSIDE BLVD
LOVES PARK, IL 61111

Pharmacy Comments

Contract Details

Approval Date

7/14/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Michael Moss, Associate Vice Chancellor, Budget & Financial Analysis
(312) 996-0306

Contract Pharmacy Representative

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

Signed By Date

7/14/2021

340B Drug Pricing Program Database