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VITAL RX, LLC
RWI60614 Chicago House and Social Service Agency
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Covered Entity Details
Entity Name
Chicago House and Social Service Agency
Subdivision Name
Type
Ryan White Part A
340B ID
RWI60614
Entity Address
2229 S Michigan Avenue
Suite 304
Chicago, IL 60616
Grant Number
H89HA00008
Participating Start Date
10/1/2016
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
VITAL RX, LLC
Pharmacy Address
3110 W BELMONT AVE STE 1W
CHICAGO, IL 60618
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Andrea Peoples, Chief Financial Officer
(773) 248-5200 Ext: 301
Contract Pharmacy Representative
Vital RX
Anup Doshi, President
(773) 862-1699
Signed By Date
10/14/2019
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