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AVITA PHARMACY 1073
STD787021 CHE Center for Health Empowerment
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Covered Entity Details
Entity Name
CHE Center for Health Empowerment
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD787021
Entity Address
2312 Western Trails Blvd
Ste 103
Austin, TX 78745
Grant Number
NH25PS005182
Participating Start Date
7/1/2017
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1073
Pharmacy Address
AVITA DRUGS LLC DBA AVITA PHARMACY 1073
300 SOUTH 2ND STREET
SUIT 102
MCALLEN, TX 78501
Pharmacy Comments
Contract Details
Approval Date
7/2/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Valerie Agee, Chief Operations Officer
(512) 840-1273
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
7/2/2018
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