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AVITA PHARMACY 1073
STD75234 Center for Health Empowerment
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Covered Entity Details
Entity Name
Center for Health Empowerment
Subdivision Name
Center for Health Empowerment Dallas County
Type
Sexually Transmitted Diseases
340B ID
STD75234
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 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
5/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/14/2022
Business decision by covered entity and/or pharmacy
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
4/15/2019
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