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AVITA PHARMACY 1036
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 1036
Pharmacy Address
3100 RED RIVER ST STE 3A
AUSTIN, TX 78705
Pharmacy Comments
Contract Details
Approval Date
1/11/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Benjamin P Walker, Director
(512) 467-0088 Ext: 133
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
1/11/2021
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