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GEORGIA CVS PHARMACY, L.L.C.
RWI30058A AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Atlanta Midtown
Type
Ryan White Part A
340B ID
RWI30058A
Entity Address
735 Piedmont Avenue NE
Atlanta, GA 30308
Grant Number
H89HA00007
Participating Start Date
4/1/2017
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
GEORGIA CVS PHARMACY, L.L.C.
Pharmacy Address
DBA: CVS/PHARMACY # 04178
895 RALPH ABERNATHY BLVD., SW
ATLANTA, GA 30310
Pharmacy Comments
Contract Details
Approval Date
10/10/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022
Contract Pharmacy Representative
CVS Health
Christian J Reid, 340B Program Director
(401) 374-9782
Signed By Date
10/10/2022
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