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SOUTHSIDE INFUSION
RWI78208 San Antonio AIDS Foundation
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Covered Entity Details
Entity Name
San Antonio AIDS Foundation
Subdivision Name
Type
Ryan White Part A
340B ID
RWI78208
Entity Address
818 East Grayson Street
San Antonio, TX 78208-1013
Grant Number
H89HA31891
Participating Start Date
1/1/2013
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
SOUTHSIDE INFUSION
Pharmacy Address
7700 MAIN ST STE 210
HOUSTON, TX 77030-4457
Pharmacy Comments
Contract Details
Approval Date
10/6/2015
Contract Begin Date
1/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David T. Ewell, Executive Director
(210) 225-4715 Ext: 122
Contract Pharmacy Representative
ACCT
Nandan Kumar, Director of Pharmacy Operations
(713) 660-8888 Ext: 1220
Signed By Date
10/6/2015
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