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AHF PHARMACY
HV00123 AIDS Outreach Center, Inc.
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Covered Entity Details
Entity Name
AIDS Outreach Center, Inc.
Subdivision Name
Type
Ryan White Part C
340B ID
HV00123
Entity Address
400 N. Beach Street
Suite 100
Fort Worth, TX 76111-7010
Grant Number
H76HA00123
Participating Start Date
1/1/2021
Last Recertification Date
Entity Termination Date
4/1/2021
Pharmacy Details
Pharmacy Name
AHF PHARMACY
Pharmacy Address
AIDS HEALTHCARE FOUNDATION
400 N BEACH ST STE 102
FORT WORTH, TX 76111
Pharmacy Comments
Contract Details
Approval Date
11/30/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Patrice M Williams, Executive Director
(817) 916-5206
Contract Pharmacy Representative
AHF
Andrew Killeen, Pharmacy Director
(470) 379-4209
Signed By Date
10/2/2020
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