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AVITA PHARMACY 1029
STD787448 Austin Public Health
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Covered Entity Details
Entity Name
Austin Public Health
Subdivision Name
Communicable Diseases Unit
Type
Sexually Transmitted Diseases
340B ID
STD787448
Entity Address
15 WALLER STREET
AUSTIN, TX 78702
Grant Number
NH25PS005182
Participating Start Date
1/1/1995
Last Recertification Date
5/14/2025
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
1/8/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
SAEED AZADI, Public Health Division Manager
(512) 972-5413
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/8/2021
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