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BIENESTAR PHARMACY III 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
BIENESTAR PHARMACY III INC.
Pharmacy Address
2359 S WESTERN AVE STE 100
CHICAGO, IL 60608
Pharmacy Comments
Contract Details
Approval Date
10/12/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jerome Montgomery, Executive Director
(773) 426-5997
Contract Pharmacy Representative
Bienestar Pharmacy
Snejal Bhavsar, Senior Associate
(630) 452-3938
Signed By Date
10/12/2021
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