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RECEPT PHARMACY LP
RWII606401 TPA Network
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Covered Entity Details
Entity Name
TPA Network
Subdivision Name
Type
Ryan White Part B
340B ID
RWII606401
Entity Address
5537 North Broadway
Chicago, IL 60640
Grant Number
X07HA00013
Participating Start Date
4/1/2020
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
RECEPT PHARMACY LP
Pharmacy Address
DBA RECEPT PHARMACY #125
5501 S HALSTED ST STE 147
CHICAGO, IL 60621-2229
Pharmacy Comments
Contract Details
Approval Date
2/20/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Julie Anne Supple, Interim CEO/Director of Client Services
(773) 989-9400 Ext: 240
Contract Pharmacy Representative
Recept Pharmacy
Samantha Gould, Director of Client Services
(817) 602-2332
Signed By Date
1/13/2020
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