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VIVENT PHARMACY LLC
HV00127 Vivent Health Texas, Inc.
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Covered Entity Details
Entity Name
Vivent Health Texas, Inc.
Subdivision Name
AIDS Services of Austin
Type
Ryan White Part C
340B ID
HV00127
Entity Address
104 E Highland Mall Blvd
Suite 100
Austin, TX 78752
Grant Number
H76HA00127
Participating Start Date
7/1/2017
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
VIVENT PHARMACY LLC
Pharmacy Address
DBA VIVENT PHARMACY
1311 N 6TH ST STE 101
MILWAUKEE, WI 53212
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/9/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Paul Scott, C.E.O.
(512) 458-2437
Contract Pharmacy Representative
AIDS Resource Center of Wisconsin
Daniel Guinn, VP of Compliance & General Counsel
(608) 316-8602
Signed By Date
1/15/2020
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