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AVITA PHARMACY 1058
STD78666 The Wright House Wellness Center DBA ASHWELL
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Covered Entity Details
Entity Name
The Wright House Wellness Center DBA ASHWELL
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78666
Entity Address
611 Martin Luther King Drive
San Marcos, TX 78666
Grant Number
NH25PS005182
Participating Start Date
7/1/2019
Last Recertification Date
5/14/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1058
Pharmacy Address
MEDEXPRESS PHARMACY, LTD. DBA AVITA PHAR
1431 W. INNES ST.
SALISBURY, NC 28144
Pharmacy Comments
Contract Details
Approval Date
7/15/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Lauren Potter, Executive Director
(512) 467-0088
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
7/15/2019
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