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RECEPT PHARMACY #1
RWII60608 Alliance Care 360
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Covered Entity Details
Entity Name
Alliance Care 360
Subdivision Name
Type
Ryan White Part B
340B ID
RWII60608
Entity Address
2929 S Wabash Avenue
Suite
202
Chicago, IL 60616-2327
Grant Number
X07HA00013-27-00
Participating Start Date
4/1/2016
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
RECEPT PHARMACY #1
Pharmacy Address
800 8TH AVE STE 130
FORT WORTH, TX 76104
Pharmacy Comments
Contract Details
Approval Date
1/17/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ariq Cabbler, Executive Director
(312) 808-1044 Ext: 101
Contract Pharmacy Representative
Recept
Vaughn Kinosian, Vice President of Operations
(401) 952-8627
Signed By Date
1/17/2017
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