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VIVENT PHARMACY LLC
HV54203 Vivent Health
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Covered Entity Details
Entity Name
Vivent Health
Subdivision Name
Type
Ryan White Part C
340B ID
HV54203
Entity Address
1311 N 6th Street
MILWAUKEE, WI 53212
Grant Number
H76HA00621
Participating Start Date
4/1/2003
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
VIVENT PHARMACY LLC
Pharmacy Address
DBA VIVENT PHARMACY
600 WILLIAMSON ST STE H
MADISON, WI 53703
Pharmacy Comments
Contract Details
Approval Date
10/2/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/15/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Gifford, CEO
(414) 225-1547
Contract Pharmacy Representative
Richard Fons, Vice President of Pharmacy Services
(414) 223-6832
Signed By Date
10/2/2015
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