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31ST & 3RD PHARMACY INC
RWI60505 OPEN DOOR CLINIC OF GREATER ELGIN
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Covered Entity Details
Entity Name
OPEN DOOR CLINIC OF GREATER ELGIN
Subdivision Name
AURORA CLINIC
Type
Ryan White Part A
340B ID
RWI60505
Entity Address
157 S. LINCOLN AVENUE
Suite K
AURORA, IL 60505
Grant Number
H89HA00008
Participating Start Date
4/1/2012
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
31ST & 3RD PHARMACY INC
Pharmacy Address
D/B/A AVITA PHARMACY 1063
1860 WALT WHITMAN RD STE 700
MELVILLE, NY 11747
Pharmacy Comments
Contract Details
Approval Date
1/16/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Perry Maier, Executive Director
(847) 695-1093
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/16/2024
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