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AVITA PHARMACY 1029
RWI77036 ST. HOPE FOUNDATION, INC.
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Covered Entity Details
Entity Name
ST. HOPE FOUNDATION, INC.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI77036
Entity Address
6200 SAVOY DRIVE
SUITE 540
HOUSTON, TX 77036
Grant Number
H89HA00004
Participating Start Date
12/8/2005
Last Recertification Date
2/18/2025
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
2/25/2010
Contract Begin Date
2/25/2010
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timika Sam-Cooper, Chief Operations Officer
(713) 778-1300 Ext: 2342
Contract Pharmacy Representative
MIKE MCBRIDE, DIRECTOR OF PHARMACY
(210) 231-0383
Signed By Date
2/17/2010
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