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SHIVAADI CORPORATION
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
SHIVAADI CORPORATION
Pharmacy Address
3303 S HALSTED ST
CHICAGO, IL 60608-6877
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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