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UNIVERSITY OF ILLINOIS MILE SQUARE PHARM
CH05758H University of Illinois
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Covered Entity Details
Entity Name
University of Illinois
Subdivision Name
Mile Square IHC New City Clinic
Type
HRSA-Funded Health Center
340B ID
CH05758H
Entity Address
734 West 47th Street
Chicago, IL 60609-4411
Grant Number
H80CS00324
Participating Start Date
1/1/2013
Last Recertification Date
3/4/2016
Entity Termination Date
4/1/2017
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
4/1/2017
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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