Contract Pharmacy Details

WALGREEN CO.
HV01710B AIDS Arms, Inc. d/b/a Prism Health North Texas

Covered Entity Details

Entity Name

AIDS Arms, Inc. d/b/a Prism Health North Texas

Subdivision Name

Uptown Clinic

Type

Ryan White Part C

340B ID

HV01710B

Entity Address

2801 Lemmon Ave
Suite 400
Dallas, TX 75204

Grant Number

H76HA01710

Participating Start Date

4/1/2019

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 04203
438 W. ILLINOIS AVE.
DALLAS, TX 75224

Pharmacy Comments

Contract Details

Approval Date

10/15/2019

Contract Begin Date

1/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

John T. Carlo, CEO
(214) 521-5191

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/15/2019

340B Drug Pricing Program Database