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PHARMBLUE ILLINOIS LLC
RWII60606 AIDS Foundation of Chicago
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Covered Entity Details
Entity Name
AIDS Foundation of Chicago
Subdivision Name
Type
Ryan White Part B
340B ID
RWII60606
Entity Address
200 W. Monroe St
STE 1150
Chicago, IL 60606
Grant Number
X07HA00013
Participating Start Date
1/1/2018
Last Recertification Date
2/10/2025
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
10/27/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/10/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
John Peller, President & CEO
(312) 334-0921
Contract Pharmacy Representative
PharmBlue
Gabriel Santry, Director of National Accounts
(724) 779-4720 Ext: 017
Signed By Date
10/11/2017
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