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AVITA PHARMACY 1073
RWI78754 The Wright House Wellness Center DBA ASHWELL
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Covered Entity Details
Entity Name
The Wright House Wellness Center DBA ASHWELL
Subdivision Name
Type
Ryan White Part A
340B ID
RWI78754
Entity Address
3100 Red River St.
STE 3
Austin, TX 78705
Grant Number
H89HA00036-31-00
Participating Start Date
7/1/2018
Last Recertification Date
3/6/2025
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
7/10/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lauren Potter, Executive Director
(512) 467-0088
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
7/10/2018
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