Contract Pharmacy Details

AVITA PHARMACY 1036
STD78216 Texas Health Action

Covered Entity Details

Entity Name

Texas Health Action

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD78216

Entity Address

730 Isom Road
San Antonio, TX 78216

Grant Number

NH25PS005182

Participating Start Date

10/1/2017

Last Recertification Date

5/28/2024

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1036

Pharmacy Address

3100 RED RIVER ST STE 3A
AUSTIN, TX 78705

Pharmacy Comments

Contract Details

Approval Date

1/17/2023

Contract Begin Date

4/1/2023

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Chris Adams, CFO
(512) 643-8770

Contract Pharmacy Representative

Avita
Chris Creamer, COO
(469) 592-2000

Signed By Date

1/17/2023