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KROGER PHARMACY #451
HV01710 AIDS ARMS, INC. d/b/a Prism Health North Texas
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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 #451
Pharmacy Address
1060 N MAIN STREET
EULESS, TX 76039
Pharmacy Comments
Contract Details
Approval Date
10/12/2020
Contract Begin Date
1/1/2021
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
10/12/2020
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