340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1028
RW424837A AIDS ARMS, INC. d/b/a/ Prism Health North Texas
Print
Covered Entity Details
Entity Name
AIDS ARMS, INC. d/b/a/ Prism Health North Texas
Subdivision Name
South Dallas Clinic
Type
Ryan White Part D
340B ID
RW424837A
Entity Address
4922 Spring Ave
DALLAS, TX 75210-1359
Grant Number
H12HA24837
Participating Start Date
4/1/2013
Last Recertification Date
2/10/2022
Entity Termination Date
10/1/2022
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
4/5/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/10/2020
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
John T. Carlo, CEO
(214) 521-5191
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
4/5/2017
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session