Contract Pharmacy Details

MISSOURI CVS PHARMACY, L.L.C.
HV01710D 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

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

MISSOURI CVS PHARMACY, L.L.C.

Pharmacy Address

DBA: CVS/PHARMACY # 05719
621 SW 3RD STREET
LEES SUMMIT, MO 64063

Pharmacy Comments

Contract Details

Approval Date

9/22/2021

Contract Begin Date

10/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/14/2024
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

John T. Carlo, CEO
(214) 521-5191

Contract Pharmacy Representative

CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782

Signed By Date

9/22/2021

340B Drug Pricing Program Database