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AVITA PHARMACY 1023
STD94610 Oakland LGBTQ Community Center
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Covered Entity Details
Entity Name
Oakland LGBTQ Community Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD94610
Entity Address
3207 Lakeshore Ave
Oakland, CA 94610
Grant Number
1H25PS005127
Participating Start Date
4/1/2023
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1023
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
6100 REDWOOD BLVD STE A
NOVATO, CA 94945-4501
Pharmacy Comments
Contract Details
Approval Date
4/8/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2022
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Joe Hawkins, CEO
(510) 882-2286
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
3/23/2021
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