| Addresses | Shipping Address | Delete | Group Change Request | AHF Pharmacy- Westside
99 N. La Cienega
Suite 200
Beverly Hills, CA 90211 | | 4/15/2025 11:28 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | AHF Pharmacy - Westside
8641 WILSHIRE BLVD
STE 200
BEVERLY HILLS, CA 90211 | 4/15/2025 11:28 AM |
| Details | Assistance Received From Date | Update | Change Request | 3/1/2024 12:00:00 AM | 3/1/2025 12:00:00 AM | 3/17/2025 11:54 AM |
| Details | Assistance Received To Date | Update | Change Request | 2/28/2025 12:00:00 AM | 2/28/2026 12:00:00 AM | 3/17/2025 11:54 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 3/7/2025 4:12 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 003124620A | 3/7/2025 4:12 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 3/7/2025 4:12 PM |
| Details | Last Recertification Date | Update | Recertification | 2/27/2024 2:52:21 PM | 2/20/2025 5:09:37 PM | 2/20/2025 5:09 PM |
| Addresses | Shipping Address | Insert | Group Change Request | | AHF Pharmacy- West
18421 South Main Street
Gardena, CA 90248 | 11/25/2024 8:38 AM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1730705047 | 8/26/2024 5:36 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 8/26/2024 5:36 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1356729164 | 8/26/2024 5:36 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 8/26/2024 5:36 PM |
| Addresses | Shipping Address | Update | Change Request | AHF Pharmacy- Castro
4071 18th Street
San Francisco, CA 94114 | AHF Pharmacy- Castro
518a Castro Street
San Francisco, CA 94114 | 8/5/2024 7:14 AM |
| Addresses | Shipping Address | Delete | Change Request | AHF Pharmacy- Midtown
1605 Peachtree Street NE
Atlanta, GA 30309 | | 8/5/2024 7:14 AM |
| Addresses | Shipping Address | Delete | Change Request | AHF Pharmacy- Oakland Park
1164 E. Oakland Park Blvd.
3rd Floor
Oakland Park, FL 33334 | | 8/5/2024 7:14 AM |
| Addresses | Shipping Address | Delete | Change Request | AHF Pharmacy- Carolina
Carr. 848 KM 1.0 Saint Just
Trujilo Alto, PR 00978 | | 8/5/2024 7:14 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy - Baltimore
2510 Saint Paul Street Fl 1
Baltimore, MD 21218 | 8/5/2024 7:14 AM |
| Details | Assistance Received From Date | Update | Change Request | 3/1/2023 12:00:00 AM | 3/1/2024 12:00:00 AM | 6/24/2024 10:35 AM |
| Details | Assistance Received To Date | Update | Change Request | 2/28/2024 12:00:00 AM | 2/28/2025 12:00:00 AM | 6/24/2024 10:35 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | AHF Pharmacy - Austin
2927 GUADALUPE ST
Austin, TX 78705-3721 | 4/1/2024 6:28 AM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- South Beach
4308 Alton Road
Suite 950
Miami Beach, FL 33140 | | 2/27/2024 2:52 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- South Beach
4308 Alton Road
Suite 870
Miami Beach, FL 33140 | 2/27/2024 2:52 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy - Capitol Hill
650 Pennsylvania Ave.
Suite 380
Washington, DC 20003 | 2/27/2024 2:52 PM |
| Details | Last Recertification Date | Update | Recertification | 3/1/2023 2:06:13 PM | 2/27/2024 2:52:21 PM | 2/27/2024 2:52 PM |
| Details | Entity Subname | Update | Recertification | AHF Healthcare Center - Gurley | AHF Healthcare Center - Auburn | 2/27/2024 2:52 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1902167141 (GA) | | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1164886727 (GA) | | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1215381157 (GA) | | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1366991283 (GA) | | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Number | Delete | Change Request | 1316449895 (GA) | | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 003176101A | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 003175370A | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 003182925A | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 003209118A | 12/19/2023 2:47 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/19/2023 2:47 PM |
| Details | NOFO Number | Update | | HRSA-22-018 | | 12/16/2023 10:34 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1902167141 | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1164886727 | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1215381157 | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1366991283 | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 1316449895 | 12/15/2023 8:12 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1902167141 | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1164886727 | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1215381157 | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1366991283 | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1316449895 | 12/15/2023 8:12 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | GA | 12/15/2023 8:12 PM |
| Addresses | Shipping Address | Insert | Group Change Request | | AHF Pharmacy - Oakland Park
2866 E Oakland Park
2nd FL
Ft Lauderdale, FL 33306 | 7/21/2023 8:26 AM |
| Addresses | Shipping Address | Insert | Group Change Request | | AHF Pharmacy - Peachtree
1438 W. Peachtree NW
Atlanta, GA 30309 | 7/21/2023 8:26 AM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Baltimore
11 E. Lexington Street
Suite 100
Baltimore, MD 21202 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Chelsea
352 7th Ave.
Suite 1206
New York, NY 10001 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Cheshire Bridge
659 Auburn Ave.
Suite 156
Atlanta, GA 30312 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Hillcrest North
1988 Hacienda Drive
Vista, CA 92081 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Hollywood
1300 N. Vermont Ave.
Suite 407
Los Angeles, CA 90027 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Jamaica
161-21 Jamaica Ave.
7th Floor
Jamaica, NY 11432 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Mi Farmacia San Ysidro
4630 Border Village Road
San Ysidro, CA 92173 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Miami Beach
4308 Alton Road
Suite 950
Miami Beach, FL 33140 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- New Hollywood
4905 Hollywood Blvd.
Los Angeles, CA 90027 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- North Las Vegas
3201 S. Maryland Pkwy.
Suite 218
Las Vegas, NV 89109 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- Priority
3580 5th Avenue
Suite 200
San Diego, CA 92103-5017 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Recertification | AHF Pharmacy- San Juan
Carr. 848 KM 1.0 Saint Just
Trujilo Alto, PR 00978 | | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Carolina
Paseo Del Prado Shopping Center Nivel
Suite 107
Carolina, PR 00987 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Manhattan
352 7th Ave.
Suite 1206
New York, NY 10001 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Gurley
659 Auburn Ave.
Suite 156
Atlanta, GA 30312 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Vista
1988 Hacienda Drive
Vista, CA 92081 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- ACQC (Queens)
161-21 Jamaica Ave.
7th Floor
Jamaica, NY 11432 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Mi Farmacia San Ysidro
4630 Border Village Road
Suite K
San Ysidro, CA 92173 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- South Beach
4308 Alton Road
Suite 950
Miami Beach, FL 33140 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Flagship Hollywood
4905 Hollywood Blvd.
Los Angeles, CA 90027 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Las Vegas
3201 S. Maryland Pkwy.
Suite 218
Las Vegas, NV 89109 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Flagship San Diego
3580 5th Avenue
Suite 200
San Diego, CA 92103-5017 | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Insert | Recertification | | AHF Pharmacy- Carolina
Carr. 848 KM 1.0 Saint Just
Trujilo Alto, PR 00978 | 3/1/2023 2:06 PM |
| Details | Assistance Received From Date | Update | Recertification | 3/1/2022 12:00:00 AM | 3/1/2023 12:00:00 AM | 3/1/2023 2:06 PM |
| Details | Assistance Received To Date | Update | Recertification | 2/28/2023 12:00:00 AM | 2/28/2024 12:00:00 AM | 3/1/2023 2:06 PM |
| Details | Last Recertification Date | Update | Recertification | | 3/1/2023 2:06:13 PM | 3/1/2023 2:06 PM |
| Addresses | Shipping Address | Delete | Change Request | AHF Pharmacy- Wilton Manors
2097 Wilton Drive
Wilton Manors, FL 33305 | | 6/23/2022 2:23 PM |
| Addresses | Shipping Address | Update | Change Request | AHF Pharmacy- Chicago
3311 N. Halsted Street
Chicago, IL 60665-2412 | AHF Pharmacy- Chicago
3311 N. Halsted Street
Chicago, IL 60657-2412 | 6/21/2022 6:51 AM |
| Addresses | Shipping Address | Update | Change Request | AHF Pharmacy- Columbia
3661 Miami Ave.
Suite 806
Miami, FL 33133 | AHF Pharmacy- Columbia
3025 Farrow Road
Columbia, SC 29203 | 6/21/2022 6:51 AM |
| Addresses | Shipping Address | Update | Change Request | AHF Pharmacy- Jackson
766 Lakeland Drive
Suite A
Jackson, MO 39216 | AHF Pharmacy- Jackson
766 Lakeland Drive
Suite A
Jackson, MS 39216 | 6/21/2022 6:51 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Columbus
1230 N. High Street
Columbus, OH 43201 | 6/21/2022 6:51 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Coconut Grove
3661 S. Miami Avenue
Suite 806
Miami, FL 33133 | 6/21/2022 6:51 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- ACC Fort Lauderdale
700 S.E. 3rd Avenue
Suite 100
Fort Lauderdale, FL 33316 | 6/21/2022 6:51 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Wilton Manors
2097 Wilton Drive
Wilton Manors, FL 33305 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- AHF Campus Fort Lauderdale
700 S.E. 3rd Avenue
Suite 100A
Fort Lauderdale, FL 33316 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Baltimore
11 E. Lexington Street
Suite 100
Baltimore, MD 21202 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Baton Rouge
4890 Bluebonnet Blvd.
Baton Rouge, LA 70809 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Biscayne
2400 Biscayne Blvd.
Miami, FL 33137 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Bronx
655 Morris Avenue
#2
Bronx, NY 10451-4898 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Brooklyn
475 Atlantic Ave.
Brooklyn, NY 11217 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Cabrini
901 Boren Ave.
Suite 800
Seattle, WA 98104 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Castro
4071 18th Street
San Francisco, CA 94114 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Chelsea
352 7th Ave.
Suite 1206
New York, NY 10001 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Cheshire Bridge
659 Auburn Ave.
Suite 156
Atlanta, GA 30312 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Chicago
3311 N. Halsted Street
Chicago, IL 60665-2412 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- City View
2307 Astoria Blvd.
Astoria, NY 11102 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Cleveland
2829 Euclid Avenue
Cleveland, OH 44115 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Columbia
3661 Miami Ave.
Suite 806
Miami, FL 33133 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Dallas
3920 Cedar Springs Road
Dallas, TX 75219 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Dallas (Medical Center)
7777 Forest Lane
Suite B-A80
Dallas, TX 75230 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Dallas Market Center
2600 N. Stemmons Fwy.
Suite 141-A
Dallas, TX 75207-2113 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Delray Beach
200 Congress Park Drive
Suite 210
Delray Beach, FL 33445 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Downtown
1400 S. Grand Ave.
Suite 801
Los Angeles, CA 90015 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- East Los Angeles
5356 Whittier Blvd.
Los Angeles, CA 90022 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Farmingdale
619 Main Street
Farmingdale, NY 11735 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Fort Worth
400 N. Beach Street
Suite 102
Fort Worth, TX 76111 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Gardena
19300 S. Hamilton Avenue
Suite 170/180
Gardena, CA 90248 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Hillcrest North
1988 Hacienda Drive
Vista, CA 92081 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Hillcrest Pharmacy
120 University Ave.
San Diego, CA 92103 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Hollywood
1300 N. Vermont Ave.
Suite 407
Los Angeles, CA 90027 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Houston (Binz)
1200 Binz Street
Suite 1040
Houston, TX 77004 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Houston OTC
1435 Westheimer Road
Houston, TX 77006 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Jackson
766 Lakeland Drive
Suite A
Jackson, MO 39216 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy-Jackson North
100 N.W. 170th Street
Suite 208
North Miami Beach, FL 33169 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Jacksonville
2 Shircliff Way
Suite 900
Jacksonville, FL 32204 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Jamaica
161-21 Jamaica Ave.
7th Floor
Jamaica, NY 11432 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Lithonia
5700 Hillandale Drive
Suite 100
Lithonia, GA 30058 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Long Beach
3500 E. Pacific Coast Highway
Long Beach, CA 90804 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Mi Farmacia San Ysidro
4630 Border Village Road
San Ysidro, CA 92173 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Miami Beach
4308 Alton Road
Suite 950
Miami Beach, FL 33140 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Midtown
1605 Peachtree Street NE
Atlanta, GA 30309 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- New Hollywood
4905 Hollywood Blvd.
Los Angeles, CA 90027 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Newnan
770 Greison Trail
Suite H
Newnan, GA 30263 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- North Las Vegas
3201 S. Maryland Pkwy.
Suite 218
Las Vegas, NV 89109 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- North Point
6333 N. Federal Highway
Suite 301
Fort Lauderdale, FL 33308 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Oakland
400 30th Street
Suite 300
Oakland, CA 94609 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Oakland Park
1164 E. Oakland Park Blvd.
3rd Floor
Oakland Park, FL 33334 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Orlando
1701 N. Mills Avenue
Orlando, FL 32803 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Orlando OTC
1349 N. Mills Avenue
Orlando, FL 32803-2542 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Pensacola
4300 Bayou Blvd.
Suite 17D
Pensacola, FL 32503 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Philadelphia
1211 Chestnut Street
Suite 405
Philadelphia, PA 19107 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Piedmont
735 Piedmont Ave. NE
Atlanta, GA 30308-1416 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Pike Street
1016 East Pike Street
Suite 100
Seattle, WA 98122 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Priority
3580 5th Avenue
Suite 200
San Diego, CA 92103-5017 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Safety Harbor
3135 SR 580
Suite 1
Safety Harbor, FL 34695 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- San Juan
Carr. 848 KM 1.0 Saint Just
Trujilo Alto, PR 00978 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- St. Petersburg
3400 26th Ave. S.
St. Petersburg, FL 33711 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Sunrise
1785 E. Sunrise Blvd.
Fort Lauderdale, FL 33304 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Valley
4940 Van Nuys Blvd.
Suite 200
Sherman Oaks, CA 91403 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Washington D.C
2141 K Street NW
Suite 707
Washington, DC 20037 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- West Hollywood
8212 Santa Monica Blvd.
West Hollywood, CA 90046 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- West Palm Beach
1411 N. Flagler Drive
Suite 9300
West Palm Beach, FL 33401-3421 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Westside
99 N. La Cienega
Suite 200
Beverly Hills, CA 90211 | 6/14/2022 6:12 AM |
| Addresses | Shipping Address | Insert | Change Request | | AHF Pharmacy- Wilton Manors
2097 Wilton Drive
Wilton Mannors, FL 33305 | 6/14/2022 6:12 AM |
| Details | State | Update | OPA Edit | Approved | Active | 6/10/2022 7:32 AM |
| Dates | Start Date | Update | OPA Edit | 7/1/2022 12:00:00 AM | 6/10/2022 12:00:00 AM | 6/10/2022 7:32 AM |
| Contacts | Signed By | Insert | New Registration | | DeStefano, Rena
Director of Pharmacy Finance
AIDS Healthcare Foundation
6313702022 | 6/10/2022 7:28 AM |
| Details | 340B ID | Update | New Registration | | RWI30058B | 6/10/2022 7:28 AM |
| Dates | Participating Approval Date | Update | New Registration | | 6/10/2022 7:28:20 AM | 6/10/2022 7:28 AM |
| Details | State | Update | New Registration | Pending | Approved | 6/10/2022 7:28 AM |
| Dates | Signed By Date | Update | New Registration | | 6/7/2022 3:50:13 PM | 6/10/2022 7:28 AM |
| Dates | Start Date | Update | New Registration | | 7/1/2022 12:00:00 AM | 6/10/2022 7:28 AM |
| Addresses | Main Address | Insert | New Registration | |
659 Auburn Ave NE Ste 156
Atlanta, GA 30312 | 6/7/2022 3:50 PM |
| Addresses | Billing Address | Insert | New Registration | | AIDS Healthcare Foundation
6255 West Sunset Blvd. 21st Floor
Los Angeles, CA 90028 | 6/7/2022 3:50 PM |
| Contacts | Primary Contact | Insert | New Registration | | Altstaedter, Barry
Director of Pharmacy Finance
AIDS Healthcare Foundation
6318705169 | 6/7/2022 3:50 PM |
| Contacts | Authorizing Official | Insert | New Registration | | DeStefano, Rena
Director of Pharmacy Finance
AIDS Healthcare Foundation
6313702022 | 6/7/2022 3:50 PM |
| Details | Assistance Received From Date | Insert | New Registration | | 3/1/2022 12:00:00 AM | 6/7/2022 3:50 PM |
| Details | Assistance Received To Date | Insert | New Registration | | 2/28/2023 12:00:00 AM | 6/7/2022 3:50 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Details | Grant Number | Insert | New Registration | | H89HA00007 | 6/7/2022 3:50 PM |
| Details | 340B ID | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Details | Entity Name | Insert | New Registration | | AIDS Healthcare Foundation | 6/7/2022 3:50 PM |
| Details | NOFO Number | Insert | New Registration | | HRSA-22-018 | 6/7/2022 3:50 PM |
| Details | Program Code | Insert | New Registration | | RWI | 6/7/2022 3:50 PM |
| Details | Entity Subname | Insert | New Registration | | AHF Healthcare Center - Gurley | 6/7/2022 3:50 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Details | State | Insert | New Registration | | Pending | 6/7/2022 3:50 PM |
| Dates | Registration Date | Insert | New Registration | | 6/7/2022 3:50:09 PM | 6/7/2022 3:50 PM |
| Dates | Signed By Date | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Dates | Start Date | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Terminations | Termination Date | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 6/7/2022 3:50 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 6/7/2022 3:50 PM |