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AVITA PHARMACY 1028
STD75146 Center for Health Empowerment
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Covered Entity Details
Entity Name
Center for Health Empowerment
Subdivision Name
DeSoto
Type
Sexually Transmitted Diseases
340B ID
STD75146
Entity Address
951 York Drive
Ste 102
DeSoto, TX 75115
Grant Number
NH25PS005182
Participating Start Date
7/1/2019
Last Recertification Date
5/5/2025
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
5/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Scott Lyles, Board Chair
(512) 608-7298
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/12/2019
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