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UNIVERSITY OF ILLINOIS MILE SQUARE PHARM
FP60609 University of Illinois Hospital & Health Sciences System
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Covered Entity Details
Entity Name
University of Illinois Hospital & Health Sciences System
Subdivision Name
Mile Square Health Center at Back of the Yards
Type
Family Planning (Title X only)
340B ID
FP60609
Entity Address
4630 SOUTH BISHOP ST.
CHICAGO, IL 60609
Grant Number
FPHPA056139
Participating Start Date
4/1/2010
Last Recertification Date
6/8/2015
Entity Termination Date
7/1/2016
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
12/12/2012
Contract Begin Date
1/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2016
Contacts
Covered Entity Signing Official
LaMorris Perry, Associate Executive Director
(312) 413-4153
Contract Pharmacy Representative
University of Illinois Mile Square
Rhondi Inman, Assistant Director
(312) 413-1767
Signed By Date
10/12/2012
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