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MARTIN-TIPTON PHARMACY, LLC
RWII79101 Panhandle AIDS Support Organization, Inc. (PASO)
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Covered Entity Details
Entity Name
Panhandle AIDS Support Organization, Inc. (PASO)
Subdivision Name
Type
Ryan White Part B
340B ID
RWII79101
Entity Address
1501 SW 10th Ave.
Amarillo, TX 79101
Grant Number
X07HA00054
Participating Start Date
7/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
MARTIN-TIPTON PHARMACY, LLC
Pharmacy Address
MARTIN TIPTON PHARMACY
1501 S TYLER ST
AMARILLO, TX 79101
Pharmacy Comments
Contract Details
Approval Date
4/6/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Michael Timcisko, Executive Director
(806) 372-1050 Ext: 103
Contract Pharmacy Representative
Panhandle AIDS Support Organization
Melissa Smalley, RPH
(806) 373-2812
Signed By Date
4/6/2020
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