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AVITA PHARMACY 1073
HV06021C VALLEY AIDS COUNCIL
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Covered Entity Details
Entity Name
VALLEY AIDS COUNCIL
Subdivision Name
Type
Ryan White Part C
340B ID
HV06021C
Entity Address
857 E. WASHINGTON, SUITE G
BROWNSVILLE, TX 78520
Grant Number
H76HA00131
Participating Start Date
10/1/2022
Last Recertification Date
2/21/2025
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
7/6/2022
Contract Begin Date
7/12/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Rafael Kirkpatrick, 340B Program Director
(956) 428-2653
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/6/2022
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