Contract Pharmacy Details

ADVANCECARE DALLAS
RWI78212 BEAT AIDS COALITION TRUST

Covered Entity Details

Entity Name

BEAT AIDS COALITION TRUST

Subdivision Name

Type

Ryan White Part A

340B ID

RWI78212

Entity Address

208 W EUCLID AVE
SAN ANTONIO, TX 78212

Grant Number

H89HA31891

Participating Start Date

1/1/2017

Last Recertification Date

2/15/2025

Pharmacy Details

Pharmacy Name

ADVANCECARE DALLAS

Pharmacy Address

3818 CEDAR SPRINGS RD STE 104
DALLAS, TX 75219

Pharmacy Comments

Contract Details

Approval Date

5/18/2023

Contract Begin Date

5/23/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

MICHELE DURHAM, EXECUTIVE DIRECTOR
(210) 212-2266 Ext: 102

Contract Pharmacy Representative

AdvanceCare Pharmacy
Kyle Bernier, Director of Operations
(508) 971-8380

Signed By Date

5/18/2023

340B Drug Pricing Program Database