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AIDS HEALTHCARE FOUNDATION
RWII39216 AIDS Healthcare Foundation
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Covered Entity Details
Entity Name
AIDS Healthcare Foundation
Subdivision Name
AHF Healthcare Center - Jackson
Type
Ryan White Part B
340B ID
RWII39216
Entity Address
766 Lakeland Drive
Suite A
Jackson, MS 39216
Grant Number
X07HA00036
Participating Start Date
10/1/2017
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
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/14/2024
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
10/14/2024
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