Contract Pharmacy Details

PHARMBLUE ILLINOIS LLC
RWI60120 OPEN DOOR CLINIC OF GREATER ELGIN

Covered Entity Details

Entity Name

OPEN DOOR CLINIC OF GREATER ELGIN

Subdivision Name

Type

Ryan White Part A

340B ID

RWI60120

Entity Address

1665 Larkin Ave
ELGIN, IL 60123

Grant Number

H89HA00008

Participating Start Date

4/1/2012

Last Recertification Date

2/18/2025

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

4/13/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

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

340B Drug Pricing Program Database