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PHARMBLUE ILLINOIS LLC
RWII60623 Project Vida
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Covered Entity Details
Entity Name
Project Vida
Subdivision Name
Type
Ryan White Part B
340B ID
RWII60623
Entity Address
2659 South Kedvale Ave
Chicago, IL 60623
Grant Number
X07HA00013
Participating Start Date
1/1/2020
Last Recertification Date
2/14/2025
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
10/10/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerome Montgomery, Executive Director
(773) 426-5997
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
10/10/2019
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