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PHARMACY4HUMANITY
RWI761111F AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Austin
Type
Ryan White Part A
340B ID
RWI761111F
Entity Address
2927 Guadalupe Street
Austin, TX 78705
Grant Number
H89HA00036
Participating Start Date
10/1/2023
Last Recertification Date
2/22/2024
Entity Termination Date
4/1/2025
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
Contract Termination Date
Termination Reason
4/1/2025
Covered Entity Terminated
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
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