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AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
STD78207 Alamo Area Resource Center
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Covered Entity Details
Entity Name
Alamo Area Resource Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78207
Entity Address
303 N. Frio St.
San Antonio, TX 78207
Grant Number
NH25PS005182
Participating Start Date
1/1/2017
Last Recertification Date
5/7/2024
Pharmacy Details
Pharmacy Name
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
Pharmacy Address
6406 MCPHERSON RD STE 6
LAREDO, TX 78041
Pharmacy Comments
Contract Details
Approval Date
6/10/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/9/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Jose Cervantes, Executive Director
(210) 625-7193 Ext: 7193
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
6/10/2023
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