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PHARMACY4HUMANITY
RWI32204A AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Orlando Mobile Clinic
Type
Ryan White Part A
340B ID
RWI32204A
Entity Address
1701 N Mills Avenue
Orlando, FL 32803
Grant Number
H89HA00030
Participating Start Date
4/1/2013
Last Recertification Date
2/20/2025
Pharmacy Details
Pharmacy Name
PHARMACY4HUMANITY
Pharmacy Address
AHF PHARMACY
18421 S MAIN ST
GARDENA, CA 90248
Pharmacy Comments
Contract Details
Approval Date
10/4/2024
Contract Begin Date
1/1/2025
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
10/4/2024
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