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ADVANCECARE DALLAS
STD782122 BEAT AIDS Coalition Trust
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Covered Entity Details
Entity Name
BEAT AIDS Coalition Trust
Subdivision Name
Your Choice Clinic
Type
Sexually Transmitted Diseases
340B ID
STD782122
Entity Address
230 E Fredericksburg Rd
San Antonio, TX 78212
Grant Number
NU65PS923645
Participating Start Date
7/1/2018
Last Recertification Date
5/23/2025
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
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