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UPGRADE PHARMACY INC
STD60623 Project Vida Inc.
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Covered Entity Details
Entity Name
Project Vida Inc.
Subdivision Name
Project Vida Inc.
Type
Sexually Transmitted Diseases
340B ID
STD60623
Entity Address
2659 South Kedvale Ave
Chicago, IL 60623
Grant Number
NU62PS924560
Participating Start Date
7/1/2020
Last Recertification Date
5/14/2024
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
6/15/2020
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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