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AVITA PHARMACY 1028
STD731161 Equality Health Group
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Covered Entity Details
Entity Name
Equality Health Group
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD731161
Entity Address
8 SW 89th St.
STE 200
Oklahoma City, OK 73139
Grant Number
NH25PS005143
Participating Start Date
4/8/2021
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
4/8/2021
Contract Begin Date
4/8/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Cody Turpin, President
(405) 420-7328
Contract Pharmacy Representative
Long's Drugs
Ashley Ellis, Corporate Counsel
(803) 254-5884 Ext: 42309
Signed By Date
4/2/2021
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