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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD327203 Advancing Health Access
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Covered Entity Details
Entity Name
Advancing Health Access
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD327203
Entity Address
502 N Spring Garden Ave
Suite 7
suite 7
Deland, FL 32720
Grant Number
1H25PS005131
Participating Start Date
10/12/2022
Last Recertification Date
5/16/2024
Entity Termination Date
7/1/2025
Pharmacy Details
Pharmacy Name
AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
Pharmacy Address
1409 NE 26TH ST
WILTON MANORS, FL 33305
Pharmacy Comments
Contract Details
Approval Date
4/14/2023
Contract Begin Date
4/25/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2025
Covered Entity Terminated
Contacts
Covered Entity Signing Official
John Gorzynski, COO
(888) 260-6580
Contract Pharmacy Representative
Avita Pharmacy
Shawn Smith, Account Executive
(305) 906-2937
Signed By Date
4/14/2023
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