Contract Pharmacy Details

AVITA PHARMACY 1036
RWII78756 Texas Health Action

Covered Entity Details

Entity Name

Texas Health Action

Subdivision Name

Type

Ryan White Part B

340B ID

RWII78756

Entity Address

101 W. Koenig Ln
Suite 100
Austin, TX 78751

Grant Number

X07 - HA00054

Participating Start Date

10/1/2019

Last Recertification Date

3/4/2025

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