Contract Pharmacy Details

PUBLIX PHARMACY #0269
RWI30058B AIDS Healthcare Foundation

Covered Entity Details

Entity Name

AIDS Healthcare Foundation

Subdivision Name

AHF Healthcare Center - Auburn

Type

Ryan White Part A

340B ID

RWI30058B

Entity Address

659 Auburn Ave NE Ste 156
Atlanta, GA 30312

Grant Number

H89HA00007

Participating Start Date

6/10/2022

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

PUBLIX PHARMACY #0269

Pharmacy Address

3649 FLAKES MILL ROAD
DECATUR, GA 30034

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

Publix
Amin Mrugesh, 340B Program Manager
(863) 688-1188 Ext: 52388

Signed By Date

7/15/2024

340B Drug Pricing Program Database