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AVITA PHARMACY 1029
STD75215 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
South Dallas Clinic
Type
Sexually Transmitted Diseases
340B ID
STD75215
Entity Address
4922 Spring Ave
Dallas, TX 75210-1359
Grant Number
NH25PS005182
Participating Start Date
4/1/2015
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
4/10/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/31/2019
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
4/10/2017
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