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UNIVERSITY OF ILLINOIS MILE SQUARE PHARM
CH05758G University of Illinois
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Covered Entity Details
Entity Name
University of Illinois
Subdivision Name
Mile Square IHC North Center Clinic
Type
HRSA-Funded Health Center
340B ID
CH05758G
Entity Address
4221 N Lincoln Avenue
Chicago, IL 60618-2901
Grant Number
H80CS00324
Participating Start Date
1/1/2013
Last Recertification Date
3/4/2016
Entity Termination Date
10/1/2016
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
3/13/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2016
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
1/14/2013
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