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870 SOUTHERN DRUG CORP
RWII06810 Apex Community Care, Inc
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Covered Entity Details
Entity Name
Apex Community Care, Inc
Subdivision Name
Type
Ryan White Part B
340B ID
RWII06810
Entity Address
30 West Street
Danbury, CT 06810
Grant Number
X07HA00022
Participating Start Date
10/1/2017
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
870 SOUTHERN DRUG CORP
Pharmacy Address
D/B/A AVITA PHARMACY 1064
924 MYRTLE AVE
BROOKLYN, NY 11206
Pharmacy Comments
Contract Details
Approval Date
1/16/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/17/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Roberta Stewart, CEO
(203) 778-2437
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/16/2023
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