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AVITA PHARMACY 1029
STD78044 People with Ideas of Love, Liberty, Acceptance and Respect
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Covered Entity Details
Entity Name
People with Ideas of Love, Liberty, Acceptance and Respect
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78044
Entity Address
6406 McPherson Rd., Ste. 2
Laredo, TX 78041
Grant Number
NH25PS005182
Participating Start Date
1/1/2022
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
10/4/2022
Contract Begin Date
10/11/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Arturo Diaz, Co Founder
(956) 337-2881
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/4/2022
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