340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD333055 The Poverello Center Inc.
Print
Covered Entity Details
Entity Name
The Poverello Center Inc.
Subdivision Name
EXTRA Care Clinic
Type
Sexually Transmitted Diseases
340B ID
STD333055
Entity Address
2056 N Dixie Hwy
Wilton Manors, FL 33305
Grant Number
NH25PS005131
Participating Start Date
2/9/2022
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
Pharmacy Address
8601 COMMODITY CIR, SUITE 105
ORLANDO, FL 32819-9003
Pharmacy Comments
Contract Details
Approval Date
7/15/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
8/26/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Thomas S Pietrogallo, CEO
(954) 561-3663 Ext: 101
Contract Pharmacy Representative
Avita Pharmacy
Shawn Smith, Account Executive
(305) 906-2937
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