Contract Pharmacy Details

UNIVERSITY OF ILLINOIS MILE SQUARE PHARM
CH05758N UNIVERSITY OF ILLINOIS

Covered Entity Details

Entity Name

UNIVERSITY OF ILLINOIS

Subdivision Name

UNIVERSITY OF ILLINOIS MILE SQUARE HEALTH CENTER - HUMBOLDT PARK

Type

HRSA-Funded Health Center

340B ID

CH05758N

Entity Address

3240 W DIVISION ST
CHICAGO, IL 60651-2405

Grant Number

H80CS00324

Participating Start Date

4/1/2015

Last Recertification Date

2/14/2023

Entity Termination Date

1/1/2024

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

1/20/2015

Contract Begin Date

4/1/2015

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2024
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Contract Pharmacy Representative

University of Illinois Mile Square
Rhondi Inman, Assistant Director
(312) 413-1767

Signed By Date

340B Drug Pricing Program Database