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AVITA PHARMACY 1029
STD78503 BEAT AIDS Coalition Trust
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Covered Entity Details
Entity Name
BEAT AIDS Coalition Trust
Subdivision Name
HIV/STD Prevention Branch
Type
Sexually Transmitted Diseases
340B ID
STD78503
Entity Address
1401 E Ridge Road, Suite B-1
McAllen, TX 78503
Grant Number
NU65PS923645
Participating Start Date
1/1/2020
Last Recertification Date
5/20/2024
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
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHELE DURHAM, EXECUTIVE DIRECTOR
(210) 212-2266 Ext: 102
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/12/2022
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