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AVITA PHARMACY 1029
CHC28969-00 Amador Health Center, Inc.
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Covered Entity Details
Entity Name
Amador Health Center, Inc.
Subdivision Name
Amador Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC28969-00
Entity Address
999 W Amador Avenue Suite A
Las Cruces, NM 88005-2739
Grant Number
H80CS28969
Participating Start Date
1/1/2019
Last Recertification Date
2/17/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
4/4/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
2/2/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Pamela L Angell, CEO
(575) 527-5482
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
4/4/2019
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