340B Drug Pricing Program Database
AVITA PHARMACY 1028
RWI75204 Legacy Counseling Center Inc. - information as of 6/18/2025 1:16:49 AM
Covered Entity Details
Entity Name
Legacy Counseling Center Inc.
Subdivision Name
Dallas
Type
Ryan White Part A
340B ID
RWI75204
Entity Address
4054 McKinney Ave. Suite 102
Dallas, TX 75204
Grant Number
H89HA00014
Participating Start Date
4/1/2018
Last Recertification Date
Entity Termination Date
4/1/2019
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
1/26/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Melissa Grove, Executive Director
(214) 207-3953
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/10/2018
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