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SOUTHSIDE INFUSION
STD78208 San Antonio AIDS Foundation
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Covered Entity Details
Entity Name
San Antonio AIDS Foundation
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78208
Entity Address
818 E. Grayson St
San Antonio, TX 78208
Grant Number
NU62PS924529
Participating Start Date
4/1/2017
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
SOUTHSIDE INFUSION
Pharmacy Address
7700 MAIN ST STE 210
HOUSTON, TX 77030-4457
Pharmacy Comments
Contract Details
Approval Date
4/11/2017
Contract Begin Date
7/1/2017
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
Cynthia Nelson, Chief Executive Officer
(210) 225-4715 Ext: 122
Contract Pharmacy Representative
ACCT
Nandan Kumar, Director of Pharmacy Operations
(713) 660-8888 Ext: 1220
Signed By Date
4/11/2017
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