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AVITA PHARMACY 1073
STD796050 ABILENE-TAYLOR CO PUBLIC HEALTH
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Covered Entity Details
Entity Name
ABILENE-TAYLOR CO PUBLIC HEALTH
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD796050
Entity Address
850 North 6th Street
ABILENE, TX 79601
Grant Number
NH25PS005182
Participating Start Date
1/1/1995
Last Recertification Date
5/22/2025
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
4/11/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Barbara Jeffers RN, MSN, Nursing Program Director
(325) 437-4660
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
4/11/2019
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