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AVITA PHARMACY 1028
HV01710D 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
Worth Street
Type
Ryan White Part C
340B ID
HV01710D
Entity Address
4004 Worth Street
Suite 100
Dallas, TX 75246
Grant Number
H76HA01710
Participating Start Date
4/1/2021
Last Recertification Date
3/3/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
6/29/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John T. Carlo, CEO
(214) 521-5191
Contract Pharmacy Representative
Avita Drugs
KEITH FOX, CFO
(225) 236-1540
Signed By Date
6/29/2021
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