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UPGRADE PHARMACY INC
RWII60623 Project Vida
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Covered Entity Details
Entity Name
Project Vida
Subdivision Name
Type
Ryan White Part B
340B ID
RWII60623
Entity Address
2659 South Kedvale Ave
Chicago, IL 60623
Grant Number
X07HA00013
Participating Start Date
1/1/2020
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
UPGRADE PHARMACY INC
Pharmacy Address
DBA 303 UPGRADE PHARMACY
303 W LAKE ST STE 302
ADDISON, IL 60101-2586
Pharmacy Comments
Contract Details
Approval Date
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerome Montgomery, Executive Director
(773) 426-5997
Contract Pharmacy Representative
Upgrade Pharmacy
Mehul Khakhkhar, Pharmacy Manager
(708) 533-5584
Signed By Date
4/13/2020
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