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BLACK ROCK PHARMACY LLC

Company Details

Entity Name: BLACK ROCK PHARMACY LLC
Jurisdiction: Connecticut
Legal type: LLC
Citizenship: Domestic
Status: Active
Date Formed: 26 Dec 2018 (Companies founded in December 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 (Companies in Fairfield, 06825)
County: Fairfield
Place of Formation: CONNECTICUT
E-Mail: LEE.SUSAN75@GMAIL.COM

form 5500

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
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2023-01-01
Business code 446110
Sponsor’s telephone number 2038708800
Plan sponsor’s address 1838 BLACK ROCK TURNPIKE, FAIRFIELD, CT, 06825

Signature of

Role Plan administrator
Date 2024-09-12
Name of individual signing CHI LEE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Business address Mailing address Phone E-Mail 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

Officer

Name Role Business address Phone E-Mail 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

License

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

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: 11 Nov 2024

Sources: Connecticut's Official State Website