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AVITA PHARMACY 1029
STD76541 Bell County Public Health District
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Covered Entity Details
Entity Name
Bell County Public Health District
Subdivision Name
Killeen Clinic
Type
Sexually Transmitted Diseases
340B ID
STD76541
Entity Address
309 N. 2nd Street
Killeen, TX 76541
Grant Number
NH25PS005182
Participating Start Date
10/1/2018
Last Recertification Date
5/29/2024
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
10/9/2020
Contract Begin Date
1/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Amanda Robison-Chadwell, Director
(254) 773-4457
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/9/2020
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