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ADVANCECARE DALLAS
STD770022 AIDS Foundation Houston DBA/ Allies in Hope
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Covered Entity Details
Entity Name
AIDS Foundation Houston DBA/ Allies in Hope
Subdivision Name
Mobile Clinic 2
Type
Sexually Transmitted Diseases
340B ID
STD770022
Entity Address
2328 Fannin St.
Houston, TX 77002
Grant Number
5NU62PS9246850400
Participating Start Date
6/22/2023
Last Recertification Date
5/14/2025
Pharmacy Details
Pharmacy Name
ADVANCECARE DALLAS
Pharmacy Address
3818 CEDAR SPRINGS RD STE 104
DALLAS, TX 75219
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Campbell, Chief Executive Officer
(713) 623-6796 Ext: 244
Contract Pharmacy Representative
Advancecare Dallas
Kyle Bernier, Director of Operations
(214) 624-9872
Signed By Date
7/17/2023
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