Contract Pharmacy Details

RANDALLS FOOD AND DRUGS LP
HV01710B AIDS Arms, Inc. d/b/a Prism Health North Texas

Covered Entity Details

Entity Name

AIDS Arms, Inc. d/b/a Prism Health North Texas

Subdivision Name

Uptown Clinic

Type

Ryan White Part C

340B ID

HV01710B

Entity Address

2801 Lemmon Ave
Suite 400
Dallas, TX 75204

Grant Number

H76HA01710

Participating Start Date

4/1/2019

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

RANDALLS FOOD AND DRUGS LP

Pharmacy Address

TOM THUMB PHARMACY #3614
315 SOUTH HAMPTON
DALLAS, TX 75208

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

Albertsons Companies
Chuck Hanson, Senior 340B Program Manager
(208) 395-6304

Signed By Date

4/17/2020

340B Drug Pricing Program Database