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PHARMACY4HUMANITY
STD752192 AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF PHD Dallas OTC Wellness
Type
Sexually Transmitted Diseases
340B ID
STD752192
Entity Address
3920 Cedar Springs Rd.
Dallas, TX 75219
Grant Number
NH25PS005182
Participating Start Date
7/1/2022
Last Recertification Date
5/28/2024
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
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