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PHARMACY4HUMANITY
RWI761111E AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Oak Lawn
Type
Ryan White Part A
340B ID
RWI761111E
Entity Address
3920 Cedar Springs Rd.
Dallas, TX 75219
Grant Number
H89HA00014
Participating Start Date
6/13/2022
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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