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AVITA PHARMACY 1073
HV12909 THE MCGREGOR CLINIC
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Covered Entity Details
Entity Name
THE MCGREGOR CLINIC
Subdivision Name
Type
Ryan White Part C
340B ID
HV12909
Entity Address
3487 Broadway
FORT MYERS, FL 33901
Grant Number
H76HA12909
Participating Start Date
1/1/2011
Last Recertification Date
2/28/2025
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
7/17/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/22/2019
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
SHARON MURPHY, CEO / DIRECTOR
(239) 334-9555 Ext: 8018
Contract Pharmacy Representative
Avita Pharmacy
Roland Hewitt, Account Executive
(407) 866-3283
Signed By Date
7/17/2018
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