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AVITA PHARMACY 1029
RWI75215A AIDS ARMS, INC.
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Covered Entity Details
Entity Name
AIDS ARMS, INC.
Subdivision Name
Uptown Clinic
Type
Ryan White Part A
340B ID
RWI75215A
Entity Address
2801 Lemmon Ave
400
Dallas, TX 75204
Grant Number
H89HA00014
Participating Start Date
7/1/2019
Last Recertification Date
2/10/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
6/3/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/10/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John T. Carlo, CEO
(214) 521-5191
Contract Pharmacy Representative
Avita Drugs
KEITH FOX, CFO
(225) 236-1540
Signed By Date
4/15/2019
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