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AVITA PHARMACY 1030
FP77009 Houston Health Department
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Covered Entity Details
Entity Name
Houston Health Department
Subdivision Name
La Nueva Casa Health Center
Type
Family Planning (Title X only)
340B ID
FP77009
Entity Address
1809 N MAIN
HOUSTON, TX 77009
Grant Number
FPHPA006521
Participating Start Date
10/1/2004
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1030
Pharmacy Address
6800 WEST LOOP S STE 225
BELLAIRE, TX 77401
Pharmacy Comments
Contract Details
Approval Date
10/12/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephen L. Williams, Executive Director
(832) 393-5056
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/12/2018
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