Contract Pharmacy Details

VRX 1 LLC
RWI23704C Urban League of Hampton Roads

Covered Entity Details

Entity Name

Urban League of Hampton Roads

Subdivision Name

Huntersville

Type

Ryan White Part A

340B ID

RWI23704C

Entity Address

830 Goff St
Norfolk, VA 23504

Grant Number

H89HA00053

Participating Start Date

1/1/2019

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

VRX 1 LLC

Pharmacy Address

D/B/A HAGUE PHARMACY
400 GRESHAM DR # 104
NORFOLK, VA 23507

Pharmacy Comments

Contract Details

Approval Date

1/13/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Stephen L Williams, Medical Case Manager
(757) 627-0864

Contract Pharmacy Representative

Hague Pharmacy
Vish Patel, Owner
(757) 285-6001

Signed By Date

1/13/2020

340B Drug Pricing Program Database