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AVITA PHARMACY 1073
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
5/28/2025
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
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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