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UNIVERSITY OF ILLINOIS MILE SQUARE PHARM
CH05758E University of Illinois
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Covered Entity Details
Entity Name
University of Illinois
Subdivision Name
Mile Square Health Center, Davis Health and Wellness Center
Type
HRSA-Funded Health Center
340B ID
CH05758E
Entity Address
3050 W 39TH PL
CHICAGO, IL 60632-2402
Grant Number
H80CS00324
Participating Start Date
1/1/2013
Last Recertification Date
2/14/2025
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
3/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
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
1/15/2013
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