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WALGREEN CO.
HV01710A 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
South Dallas Clinic
Type
Ryan White Part C
340B ID
HV01710A
Entity Address
4922 Spring Ave
Dallas, TX 75210-1359
Grant Number
H76HA01710
Participating Start Date
7/1/2016
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #13930
11700 PRESTON RD.
SUITE 703
DALLAS, TX 75230
Pharmacy Comments
Contract Details
Approval Date
4/15/2020
Contract Begin Date
7/1/2020
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
4/15/2020
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