340B Drug Pricing Program Database
AVITA DRUGS OREGON LLC
RWII97403 HIV Alliance - information as of 4/30/2025 11:23:02 PM
Covered Entity Details
Entity Name
HIV Alliance
Subdivision Name
Type
Ryan White Part B
340B ID
RWII97403
Entity Address
1195 A City View Street
Eugene, OR 97402
Grant Number
X07HA00007
Participating Start Date
10/1/2014
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AVITA DRUGS OREGON LLC
Pharmacy Address
DBA: AVITA PHARMACY 1027
2236 SE BELMONT ST STE A
PORTLAND, OR 97214-2817
Pharmacy Comments
Contract Details
Approval Date
4/17/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Renee Yandel, Executive Director
(541) 342-5088 Ext: 118
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
4/17/2023
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