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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD328092 Helping Oppressed & Marginalized Communities to Elevate, Inc.
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Covered Entity Details
Entity Name
Helping Oppressed & Marginalized Communities to Elevate, Inc.
Subdivision Name
HOME-S
Type
Sexually Transmitted Diseases
340B ID
STD328092
Entity Address
8421 Orange Blossom Trl
Ste 124
Orlando, FL 32809
Grant Number
H25PS005131
Participating Start Date
10/1/2021
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
9/10/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/12/2022
Agreement registered in error
Contacts
Covered Entity Signing Official
Preston J Queenan, President
(484) 868-4948
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
9/10/2022
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