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ALTO PHARMACY, LLC
RWI891041A John Phoenix APRN, PLLC
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Covered Entity Details
Entity Name
John Phoenix APRN, PLLC
Subdivision Name
Type
Ryan White Part A
340B ID
RWI891041A
Entity Address
The Gay and Lesbian Center of Southern Nevada
401 S. Maryland Parkway
Las Vegas, NV 89101
Grant Number
H89HA06900
Participating Start Date
4/1/2020
Last Recertification Date
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
ALTO PHARMACY, LLC
Pharmacy Address
DBA ALTO PHARMACY
1400 TENNESSEE ST UNIT 2
SAN FRANCISCO, CA 94107-3421
Pharmacy Comments
Contract Details
Approval Date
7/9/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John Phoenix, Chief Clinical Officer
(702) 979-1111
Contract Pharmacy Representative
Alto Pharmacy
Amil Patel, Head of Pharmacy
(800) 874-5881
Signed By Date
7/9/2020
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