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WALGREEN CO.
HV01710C AIDS Arms, Inc., d/b/a Prism Health North Texas
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Covered Entity Details
Entity Name
AIDS Arms, Inc., d/b/a Prism Health North Texas
Subdivision Name
Oak Lawn Health Center
Type
Ryan White Part C
340B ID
HV01710C
Entity Address
2801 Lemmon Ave
Suite 200
Dallas, TX 75204
Grant Number
H76HA01710
Participating Start Date
10/1/2019
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
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