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AVITA PHARMACY 1073
STD79107 City of Amarillo
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Covered Entity Details
Entity Name
City of Amarillo
Subdivision Name
Amarillo Public Health
Type
Sexually Transmitted Diseases
340B ID
STD79107
Entity Address
850 Martin Rd
Amarillo, TX 79107
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
Contacts
Covered Entity Signing Official
Casie Stoughton, Director
(806) 378-6320
Contract Pharmacy Representative
Avita Pharmacy Solutions
Chip House, Account Executive
(512) 595-4036
Signed By Date
4/15/2019
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