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HV00123 AIDS Outreach Center, Inc. (Terminated)
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Main Details
Name
AIDS Outreach Center, Inc.
Subdivision Name
Type
Ryan White Part C
340B ID
HV00123
Grant Number
H76HA00123
Additional Details
Current Program Status
Terminated
Registration Date
10/2/2020
Participating Start Date
1/1/2021
Participating Approval Date
11/30/2020
Last Recertification Date
Time Period the Assistance was Received
1/1/2020 - 12/31/2020
Termination Date
Termination Reason
4/1/2021
Failure to recertify
Contacts
Authorizing Official
AIDS Outreach Center
Patrice M Williams, Executive Director
(817) 916-5206
Primary Contact
AIDS Outreach Center
Larry Ellis, Director of Administrative Services
(817) 916-5205
Addresses
Street Address
400 N. Beach Street
Suite 100
Fort Worth, TX 76111-7010
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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Participating from effective date: (7/1/2014) until terminated effective date: (4/1/2018), reinstatement effective date: (01/01/2021)
11/30/2020
June 2025
June 2025
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