340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1025
FQHCLA405 Cascade Aids Project
Print
Covered Entity Details
Entity Name
Cascade Aids Project
Subdivision Name
Prism Health
Type
Health Center Program Look-Alike
340B ID
FQHCLA405
Entity Address
2236 SE Belmont St
Portland, OR 97214-2817
Grant Number
LALCS33965
Participating Start Date
4/16/2020
Last Recertification Date
2/24/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1025
Pharmacy Address
PHARMEDQUEST PHARMACY SERVICES DBA AVITA
3020 SATURN ST STE 100
BREA, CA 92821
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Tyler A. TerMeer, Executive Director
(503) 278-3810
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/15/2022
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session