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AVITA PHARMACY 1029
STD77803 Brazos County Health District
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Covered Entity Details
Entity Name
Brazos County Health District
Subdivision Name
Community Health Services
Type
Sexually Transmitted Diseases
340B ID
STD77803
Entity Address
201 NORTH TEXAS AVENUE
BRYAN, TX 77803
Grant Number
NH25PS005182
Participating Start Date
7/1/2019
Last Recertification Date
5/5/2025
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
5/2/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Santos Navarrette Jr, Director
(979) 361-4440 Ext: 5715
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
4/15/2019
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