| Entity Name: | BLACK ROCK PHARMACY LLC |
| Jurisdiction: | Connecticut |
| Legal type: | LLC |
| Citizenship: | Domestic |
| Status: | Active |
| Sub status: | Annual report due |
| Date Formed: | 26 Dec 2018 |
| Business ALEI: | 1294239 |
| Annual report due: | 31 Mar 2025 |
| NAICS code: | 456110 - Pharmacies and Drug Retailers |
| Business address: | 1838 BLACK ROCK TURNPIKE, FAIRFIELD, CT, 06825, United States |
| Mailing address: | 1838 BLACK ROCK TURNPIKE, FAIRFIELD, CT, United States, 06825 |
| ZIP code: | 06825 |
| County: | Fairfield |
| Place of Formation: | CONNECTICUT |
| E-Mail: | LEE.SUSAN75@GMAIL.COM |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BLACK ROCK PHARMACY 401(K) PLAN | 2023 | 832942754 | 2024-09-12 | BLACK ROCK PHARMACY LLC | 4 | |||||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2024-09-12 |
| Name of individual signing | CHI LEE |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Business address | Mailing address | Phone | Residence address | |
|---|---|---|---|---|---|---|
| CHI LEE | Agent | 1838 Black Rock Tpke, Fairfield, CT, 06825, United States | 1838 Black Rock Tpke, Fairfield, CT, 06825, United States | +1 917-860-4914 | lee.susan75@gmail.com | 37 Hemlock Rdg, Weston, CT, 06883-2000, United States |
| Name | Role | Business address | Phone | Residence address | |
|---|---|---|---|---|---|
| KENNETH LEE | Officer | 1838 Black Rock Tpke, Fairfield, CT, 06825, United States | No data | No data | 196 SOUTH MAIN ST. APARTMENT A, CHESHIRE, CT, 06410, United States |
| CHI LEE | Officer | 1838 Black Rock Tpke, Fairfield, CT, 06825, United States | +1 917-860-4914 | lee.susan75@gmail.com | 37 Hemlock Rdg, Weston, CT, 06883-2000, United States |
| Credential | Credential type | Status | Status reason | Issue date | Effective date | Expiration date |
|---|---|---|---|---|---|---|
| PCY.0002386 | PHARMACY | ACTIVE | CURRENT | 2019-03-18 | 2024-09-01 | 2025-08-31 |
| Filing number | Filing date | Effective date | Filing category | Filing type | Report year |
|---|---|---|---|---|---|
| BF-0012588570 | 2024-03-20 | 2024-03-20 | Change of Agent | Agent Change | No data |
| BF-0012588545 | 2024-03-20 | 2024-03-20 | Interim Notice | Interim Notice | No data |
| BF-0012069393 | 2024-03-12 | No data | Annual Report | Annual Report | No data |
| BF-0011240524 | 2023-02-01 | No data | Annual Report | Annual Report | No data |
| BF-0010601355 | 2022-06-24 | No data | Annual Report | Annual Report | No data |
| BF-0008683537 | 2022-05-17 | No data | Annual Report | Annual Report | 2020 |
| BF-0009853515 | 2022-05-17 | No data | Annual Report | Annual Report | No data |
| 0006490716 | 2019-03-26 | No data | Annual Report | Annual Report | 2019 |
| 0006299657 | 2018-12-26 | 2018-12-26 | Business Formation | Certificate of Organization | No data |
Date of last update: 25 Nov 2024
Sources: Connecticut's Official State Website
