Covered Entity Details

STD543011 Vivent Health (Active) - information as of 6/14/2025 10:09:38 AM

Main Details

Name

Vivent Health

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD543011

Grant Number

5H25PS004336-03

Nature of Support
Please Describe the “in-kind” Support
Time period section 318 funding or in-kind support was received

In-Kind products or services (see note below; must have been purchased with section 318 funds)
Note: In-kind contributions may be in the form of real property, equipment, supplies and other expendable property, and goods and services directly benefiting and specifically identifiable to the project or program.
Lab testing supplies, consultation, technical assistance, surveillance data
9/28/2016

Additional Details

Current Program Status

Active

Registration Date

10/5/2016

Participating Start Date

1/1/2017

Participating Approval Date

10/27/2016

Last Recertification Date

5/5/2025

Notice of Funding Opportunity (NOFO) Number

PS19-190103CONT21

Contacts

Authorizing Official

Vivent Health
Timothy Denis Dyer, Executive Vice President & CFO
(414) 225-1542

Primary Contact

Vivent Health
Daniel Guinn, VP Compliance & General Counsel
(608) 316-8602

Addresses

Street Address

445 SOUTH ADAMS STREET
GREEN BAY, WI 54301

Billing Address

Vivent Health
1311 N 6th Street
Milwaukee, WI 53212

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

Vivent Pharmacy
600 Williamson Street
H
Madison, WI 53703

Shipping Address 2

Vivent Pharmacy
1311 N 6th Street
Suite 101
Milwaukee, WI 53212

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Carve-In Effective Date	Termination Date	Last Updated On
Contract Detail	VIVENT PHARMACY LLC	DBA VIVENT PHARMACY	1311 N 6TH ST STE 101	MILWAUKEE	WI	53212	10/27/2016	01/01/2017		03/15/2019	04/08/2019
Contract Detail	VIVENT PHARMACY LLC	DBA VIVENT PHARMACY	600 WILLIAMSON ST STE H	MADISON	WI	53703	01/05/2017	04/01/2017		03/15/2019	04/08/2019

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Details	Last Recertification Date	Update	Recertification	5/15/2024 12:52:18 PM	5/5/2025 10:19:18 AM	5/5/2025 10:19 AM
Details	Last Recertification Date	Update	Recertification	5/18/2023 12:39:33 PM	5/15/2024 12:52:18 PM	5/15/2024 12:52 PM
Addresses	Shipping Address	Delete	Group Change Request	Vivent Pharmacy 820 N. Plankinton Ave Milwaukee, WI 53203		6/14/2023 9:35 AM
Addresses	Shipping Address	Insert	Group Change Request		Vivent Pharmacy 1311 N 6th Street Suite 101 Milwaukee, WI 53212	6/14/2023 9:35 AM
Addresses	Billing Address	Update	Group Change Request	Vivent Health 820 NORTH PLANKINTON AVENUE MILWAUKEE, WI 53203	Vivent Health 1311 N 6th Street Milwaukee, WI 53212	6/14/2023 9:35 AM
Details	Last Recertification Date	Update	Recertification	5/12/2022 5:28:12 PM	5/18/2023 12:39:33 PM	5/18/2023 12:39 PM
Details	Last Recertification Date	Update	Recertification	5/20/2021 1:23:08 PM	5/12/2022 5:28:12 PM	5/12/2022 5:28 PM
Addresses	Shipping Address	Delete	Recertification	ARCW Pharmacy LLC DBA Vivent Pharmacy 600 Williamson Street H Madison, WI 53703		5/20/2021 1:23 PM
Addresses	Shipping Address	Delete	Recertification	ARCW Pharmacy LLC DBA Vivent Pharmacy 820 N. Plankinton Ave Milwaukee, WI 53203		5/20/2021 1:23 PM
Addresses	Shipping Address	Insert	Recertification		Vivent Pharmacy 820 N. Plankinton Ave Milwaukee, WI 53203	5/20/2021 1:23 PM
Addresses	Shipping Address	Insert	Recertification		Vivent Pharmacy 600 Williamson Street H Madison, WI 53703	5/20/2021 1:23 PM
Details	Nature of Support: In Kind Support Description	Update	Recertification		Lab testing supplies, consultation, technical assistance, surveillance data	5/20/2021 1:23 PM
Details	Nature of Support: Support Received From Date	Update	Recertification		9/28/2016 12:00:00 AM	5/20/2021 1:23 PM
Details	Last Recertification Date	Update	Recertification	5/22/2020 11:42:20 AM	5/20/2021 1:23:08 PM	5/20/2021 1:23 PM
Details	NOFO Number	Update	Recertification		PS19-190103CONT21	5/20/2021 1:23 PM
Addresses	Billing Address	Update	Change Request	AIDS RESOURCE CENTER OF WISCONSIN 820 NORTH PLANKINTON AVENUE MILWAUKEE, WI 53203	Vivent Health 820 NORTH PLANKINTON AVENUE MILWAUKEE, WI 53203	3/12/2021 7:55 AM
Details	Entity Name	Update	Change Request	AIDS RESOURCE CENTER OF WISCONSIN	Vivent Health	3/12/2021 7:55 AM
Details	Entity Subname	Update	Change Request	Vivent Health		3/12/2021 7:55 AM
Contacts	Primary Contact	Update	Change Request	Guinn, Daniel VP of Compliance & General Counsel AIDS Resource Center of Wisconsin 6083168602	Guinn, Daniel VP Compliance & General Counsel Vivent Health 6083168602	1/4/2021 1:47 PM
Contacts	Authorizing Official	Update	Change Request	Dyer, Timothy D CFO AIDS Resource Center of Wisconsin, Inc. 4142251542	Dyer, Timothy Denis Executive Vice President & CFO Vivent Health 4142251542	1/4/2021 1:47 PM
Addresses	Shipping Address	Delete	Recertification	ARCW Pharmacy LLC DBA AMC Pharmacy 820 N. Plankinton Ave Milwaukee, WI 53203		5/22/2020 11:42 AM
Addresses	Shipping Address	Delete	Recertification	ARCW Pharmacy LLC 600 Williamson Street H Madison, WI 53703		5/22/2020 11:42 AM
Addresses	Shipping Address	Insert	Recertification		ARCW Pharmacy LLC DBA Vivent Pharmacy 820 N. Plankinton Ave Milwaukee, WI 53203	5/22/2020 11:42 AM
Addresses	Shipping Address	Insert	Recertification		ARCW Pharmacy LLC DBA Vivent Pharmacy 600 Williamson Street H Madison, WI 53703	5/22/2020 11:42 AM
Details	Last Recertification Date	Update	Recertification	5/14/2019 9:17:47 AM	5/22/2020 11:42:20 AM	5/22/2020 11:42 AM
Details	Entity Subname	Update	Recertification		Vivent Health	5/22/2020 11:42 AM
Details	Last Recertification Date	Update	Recertification	4/27/2018 8:40:22 AM	5/14/2019 9:17:47 AM	5/14/2019 9:17 AM
Addresses	Shipping Address	Insert	Change Request		ARCW Pharmacy LLC DBA AMC Pharmacy 820 N. Plankinton Ave Milwaukee, WI 53203	4/11/2019 10:07 AM
Addresses	Shipping Address	Insert	Change Request		ARCW Pharmacy LLC 600 Williamson Street H Madison, WI 53703	4/11/2019 10:07 AM
Details	Last Recertification Date	Update	Recertification	5/2/2017 12:00:00 AM	4/27/2018 8:40:22 AM	4/27/2018 8:40 AM
Contacts	Primary Contact	Update	Change Request	Fons, Richard Vice President of Pharmacy Services 4142236832	Guinn, Daniel VP of Compliance & General Counsel AIDS Resource Center of Wisconsin 6083168602	10/12/2017 1:04 PM
Contacts	Authorizing Official	Update	Change Request	Gifford, Michael CEO 4142251547	Dyer, Timothy D CFO AIDS Resource Center of Wisconsin, Inc. 4142251542	10/12/2017 1:04 PM
Contacts	Signed By	Update		Gifford, Michael CEO 4142251547	Gifford, Michael CEO AIDS Resource Center of Wisconsin 4142251547	10/2/2017 3:33 PM
Addresses	Main Address	Insert			445 SOUTH ADAMS STREET GREEN BAY, WI 54301	7/12/2017 9:03 AM
Addresses	Billing Address	Insert			AIDS RESOURCE CENTER OF WISCONSIN 820 NORTH PLANKINTON AVENUE MILWAUKEE, WI 53203	7/12/2017 9:03 AM
Contacts	Authorizing Official	Insert			Gifford, Michael CEO 4142251547	7/12/2017 9:03 AM
Contacts	Signed By	Insert			Gifford, Michael CEO 4142251547	7/12/2017 9:03 AM
Contacts	Primary Contact	Insert			Fons, Richard Vice President of Pharmacy Services 4142236832	7/12/2017 9:03 AM
Details	Last Recertification Date	Update			5/2/2017 12:00:00 AM	5/2/2017 1:48 PM
Dates	Participating Approval Date	Update			10/27/2016 12:00:00 AM	10/27/2016 6:04 PM
Details	State	Update		Pending	Active	10/27/2016 6:04 PM
Dates	Start Date	Update			1/1/2017 12:00:00 AM	10/27/2016 6:04 PM
Details	340B ID	Update		ONLINE_REG_72466	STD543011	10/21/2016 11:14 AM
Details	340B ID	Update		ONLINE_REG	ONLINE_REG_72466	10/5/2016 2:17 PM
Details	Nature Of Support	Insert			In-Kind products or services (see note below; must have been purchased with section 318 funds)	10/5/2016 2:17 PM
Details	Last Recertification Date	Insert				10/5/2016 2:17 PM
Details	Grant Number	Insert			5H25PS004336-03	10/5/2016 2:17 PM
Details	340B ID	Insert			ONLINE_REG	10/5/2016 2:17 PM
Details	Is Authorizing Official EHB Data	Insert				10/5/2016 2:17 PM
Dates	Last Date That 340B Drugs Purchased	Insert				10/5/2016 2:17 PM
Details	Medicare Provider Number	Insert				10/5/2016 2:17 PM
Details	Entity Name	Insert			AIDS RESOURCE CENTER OF WISCONSIN	10/5/2016 2:17 PM
Details	Program Code	Insert			STD	10/5/2016 2:17 PM
Details	Entity Subname	Insert				10/5/2016 2:17 PM
Dates	Participating Approval Date	Insert				10/5/2016 2:17 PM
Details	State	Insert			Pending	10/5/2016 2:17 PM
Dates	Registration Date	Insert			10/5/2016 12:00:00 AM	10/5/2016 2:17 PM
Dates	Signed By Date	Insert			10/5/2016 12:00:00 AM	10/5/2016 2:17 PM
Dates	Start Date	Insert				10/5/2016 2:17 PM
Terminations	Termination Comments	Insert				10/5/2016 2:17 PM
Terminations	Termination Date	Insert				10/5/2016 2:17 PM
Terminations	Termination Effective Date	Insert				10/5/2016 2:17 PM
Terminations	Termination Reason	Insert				10/5/2016 2:17 PM

340B Drug Pricing Program Database

Comments

Medicaid Billing

Shipping Addresses

Contract Pharmacies

History