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AVITA PHARMACY 1028
STD752191 Texas Health Action
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Covered Entity Details
Entity Name
Texas Health Action
Subdivision Name
Kind Clinic
Type
Sexually Transmitted Diseases
340B ID
STD752191
Entity Address
3802 Cedar Springs Road
Dallas, TX 75219
Grant Number
NH25PS005182
Participating Start Date
7/1/2021
Last Recertification Date
5/28/2024
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
4/15/2022
Contract Begin Date
7/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Chris Adams, CFO
(512) 643-8770
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/15/2022
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