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AVITA PHARMACY 1028
STD75208 AIDS Arms, Inc.d/b/a Prism Health North Texas
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Covered Entity Details
Entity Name
AIDS Arms, Inc.d/b/a Prism Health North Texas
Subdivision Name
Oak Cliff Clinic
Type
Sexually Transmitted Diseases
340B ID
STD75208
Entity Address
219 Sunset Ave
Suite 116-A
Dallas, TX 75208
Grant Number
NH25PS005182
Participating Start Date
4/1/2015
Last Recertification Date
5/14/2024
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
1/26/2015
Contract Begin Date
4/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, FOUNDER
(504) 905-4587
Signed By Date
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