Contract Pharmacy Details

AVITA PHARMACY 1073
HV00127 Vivent Health Texas, Inc.

Covered Entity Details

Entity Name

Vivent Health Texas, Inc.

Subdivision Name

AIDS Services of Austin

Type

Ryan White Part C

340B ID

HV00127

Entity Address

104 E Highland Mall Blvd
Suite 100
Austin, TX 78752

Grant Number

H76HA00127

Participating Start Date

7/1/2017

Last Recertification Date

2/23/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1073

Pharmacy Address

AVITA DRUGS LLC DBA AVITA PHARMACY 1073
300 SOUTH 2ND STREET
SUIT 102
MCALLEN, TX 78501

Pharmacy Comments

Contract Details

Approval Date

4/16/2021

Contract Begin Date

7/1/2021

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

7/1/2022
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Timothy Denis Dyer, Executive Vice President & CFO
(414) 225-1542

Contract Pharmacy Representative

Avita
Chris Creamer, COO
(469) 592-2000

Signed By Date

4/16/2021

340B Drug Pricing Program Database