Contract Pharmacy Details

WALGREEN CO.
RWI761111 AIDS HEALTHCARE FOUNDATION

Covered Entity Details

Entity Name

AIDS HEALTHCARE FOUNDATION

Subdivision Name

AIDS HEALTHCARE CENTER - FORT WORTH

Type

Ryan White Part A

340B ID

RWI761111

Entity Address

400 N. BEACH STREET SUITE 104
FORT WORTH, TX 76111

Grant Number

H89HA00047

Participating Start Date

7/1/2014

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

WALGREEN CO.

Pharmacy Address

DBA: WALGREENS # 03735
1919 W GRAY
HOUSTON, TX 77019

Pharmacy Comments

Contract Details

Approval Date

10/12/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Philip Ho, Senior Director of Pharmacy and 340B Compliance
(323) 860-5323

Contract Pharmacy Representative

Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663

Signed By Date

10/12/2020

340B Drug Pricing Program Database