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AVITA PHARMACY 1028
STD339011 The McGregor Clinic, Inc.
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Covered Entity Details
Entity Name
The McGregor Clinic, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD339011
Entity Address
3487 Broadway
Fort Myers, FL 33901
Grant Number
NH25PS005131
Participating Start Date
7/1/2018
Last Recertification Date
6/2/2025
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
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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