Contract Pharmacy Details

AIDS HEALTHCARE FOUNDATION
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

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

340B Drug Pricing Program Database