Contract Pharmacy Details

KROGER PHARMACY
HV01710 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

Oak Cliff Clinic

Type

Ryan White Part C

340B ID

HV01710

Entity Address

219 SUNSET AVENUE
Suite 116A
DALLAS, TX 75208-4531

Grant Number

H76HA01710

Participating Start Date

1/1/2013

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

KROGER PHARMACY

Pharmacy Address

7505 N. MAC ARTHUR BLVD.
IRVING, TX 75063

Pharmacy Comments

Contract Details

Approval Date

7/16/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

8/10/2021
Business decision by covered entity and/or pharmacy

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

7/16/2020

340B Drug Pricing Program Database