Contract Pharmacy Details

KROGER PHARMACY #402
HV01710 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

Oak Cliff Clinic

Type

Ryan White Part C

340B ID

HV01710

Entity Address

219 SUNSET AVENUE
Suite 116A
DALLAS, TX 75208-4531

Grant Number

H76HA01710

Participating Start Date

1/1/2013

Last Recertification Date

3/3/2025

Pharmacy Details

Pharmacy Name

KROGER PHARMACY #402

Pharmacy Address

3612 N BELTLINE ROAD
IRVING, TX 75062

Pharmacy Comments

Contract Details

Approval Date

7/25/2023

Contract Begin Date

10/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

Kroger Health
Eva Brumfield, Strategic Program Director
(651) 357-2109

Signed By Date

7/25/2023

340B Drug Pricing Program Database