Contract Pharmacy Details

VIVENT PHARMACY LLC
HV00621B AIDS RESOURCE CENTER OF WISCONSIN

Covered Entity Details

Entity Name

AIDS RESOURCE CENTER OF WISCONSIN

Subdivision Name

MADISON OFFICE

Type

Ryan White Part C

340B ID

HV00621B

Entity Address

600 WILLIAMSON STREET
MADISON, WI 53703

Grant Number

H76HA00621

Participating Start Date

4/1/2015

Last Recertification Date

Entity Termination Date

1/1/2016

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

10/2/2015

Contract Begin Date

1/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2016

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

10/2/2015

340B Drug Pricing Program Database