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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD334093 South Florida Health and Wellness Center
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Covered Entity Details
Entity Name
South Florida Health and Wellness Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD334093
Entity Address
3017 exchange court
A-1
West Palm Beach, FL 33409
Grant Number
H25PS005131
Participating Start Date
4/1/2023
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
Pharmacy Address
8601 COMMODITY CIR, SUITE 105
ORLANDO, FL 32819-9003
Pharmacy Comments
Contract Details
Approval Date
3/29/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kristina Hernandez, Office/Client administrator
(561) 872-1401
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
3/29/2023
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