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UNITED RX LLC
STD46320 AIDS TASKFORCE OF LAPORTE AND PORTER COUNTIES d/b/a ALIVENESS PROJECT OF NORTHWEST INDIANA
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Covered Entity Details
Entity Name
AIDS TASKFORCE OF LAPORTE AND PORTER COUNTIES d/b/a ALIVENESS PROJECT OF NORTHWEST INDIANA
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD46320
Entity Address
5261 Hohman Ave
Hammond, IN 46320
Grant Number
NH25PS00513
Participating Start Date
4/1/2020
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
UNITED RX LLC
Pharmacy Address
150 FENCL LN
HILLSIDE, IL 60162
Pharmacy Comments
Contract Details
Approval Date
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tammy Morris, Executive Director
(219) 985-6170
Contract Pharmacy Representative
United/XCel-Rx, LLC
Chuck Benain, Chief Operating Officer
(708) 449-7600 Ext: 373
Signed By Date
4/14/2020
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