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AIDS HEALTHCARE FOUNDATION
HV46007A AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Pensacola
Type
Ryan White Part C
340B ID
HV46007A
Entity Address
4300 Bayou Blvd.
PENSACOLA, FL 32503
Grant Number
H76HA46008
Participating Start Date
10/1/2023
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
AIDS HEALTHCARE FOUNDATION
Pharmacy Address
AHF PHARMACY
4630 BORDER VILLAGE RD STE K
SAN YSIDRO, CA 92173
Pharmacy Comments
Contract Details
Approval Date
10/4/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/4/2024
Agreement registered in error
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
10/4/2024
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