Contract Pharmacy Details

EXPRESS SCRIPTS PHARMACY, INC.
RW424837B AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AHF HEALTHCARE CENTER - DALLAS

Type

Ryan White Part D

340B ID

RW424837B

Entity Address

7777 FOREST LANE B-122
DALLAS, TX 75230

Grant Number

H12HA24837

Participating Start Date

1/1/2016

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

EXPRESS SCRIPTS PHARMACY, INC.

Pharmacy Address

DBA EXPRESS SCRIPTS
2040 ROUTE 130 NORTH
BURLINGTON, NJ 08016

Pharmacy Comments

Contract Details

Approval Date

4/14/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Philip Ho, Senior Director of Pharmacy and 340B Compliance
(323) 860-5323

Contract Pharmacy Representative

Express Scripts
Gene McCabe, Lead Director, 340B Client Sales
(615) 943-7500

Signed By Date

4/14/2020

340B Drug Pricing Program Database