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PHARMACY4HUMANITY
RWI606161D AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Chicago - Lakeview
Type
Ryan White Part A
340B ID
RWI606161D
Entity Address
3311 N. Halsted Street
Chicago, IL 60657
Grant Number
H89HA00008
Participating Start Date
1/1/2021
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
PHARMACY4HUMANITY
Pharmacy Address
AHF PHARMACY
19300 S HAMILTON AVE STE 170-180
GARDENA, CA 90248
Pharmacy Comments
Contract Details
Approval Date
6/7/2024
Contract Begin Date
6/10/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Rena DeStefano, Director of Pharmacy Finance
(631) 370-2022
Contract Pharmacy Representative
AIDS HEALTHCARE FOUNDATION
Scott Carruthers, Chief Pharmacy Officer
(323) 860-5200 Ext: 5266
Signed By Date
6/7/2024
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