Contract Pharmacy Details

PHARMACY4HUMANITY
RWI761111E AIDS Healthcare Foundation

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
18421 S MAIN ST
GARDENA, CA 90248

Pharmacy Comments

Contract Details

Approval Date

7/15/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

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

7/15/2024

340B Drug Pricing Program Database