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KROGER PHARMACY #528
STD75204 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
Uptown Clinic
Type
Sexually Transmitted Diseases
340B ID
STD75204
Entity Address
2801 Lemmon Ave
Suite 400
Dallas, TX 75204
Grant Number
NH25PS005182
Participating Start Date
7/1/2019
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
KROGER PHARMACY #528
Pharmacy Address
4142 CEDAR SPRINGS
DALLAS, TX 75219
Pharmacy Comments
Contract Details
Approval Date
4/17/2020
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
Kroger
Anastasia Frey, Senior Manager, Payor Contracting
(513) 698-1875
Signed By Date
4/17/2020
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