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VIVENT PHARMACY LLC
HV00621A Vivent Health
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Covered Entity Details
Entity Name
Vivent Health
Subdivision Name
Type
Ryan White Part C
340B ID
HV00621A
Entity Address
1212 57TH STREET
KENOSHA, WI 53140
Grant Number
H76HA00621
Participating Start Date
1/1/2013
Last Recertification Date
2/23/2025
Pharmacy Details
Pharmacy Name
VIVENT PHARMACY LLC
Pharmacy Address
DBA VIVENT PHARMACY
600 WILLIAMSON ST STE H
MADISON, WI 53703
Pharmacy Comments
Contract Details
Approval Date
1/5/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/15/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Michael Gifford, CEO
(414) 225-1547
Contract Pharmacy Representative
Richard Fons, Vice President of Pharmacy Services
(414) 223-6832
Signed By Date
1/5/2017
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