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AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
STD782122 BEAT AIDS Coalition Trust
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Covered Entity Details
Entity Name
BEAT AIDS Coalition Trust
Subdivision Name
Your Choice Clinic
Type
Sexually Transmitted Diseases
340B ID
STD782122
Entity Address
230 E Fredericksburg Rd
San Antonio, TX 78212
Grant Number
NU65PS923645
Participating Start Date
7/1/2018
Last Recertification Date
5/28/2024
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
6/12/2023
Contract Begin Date
6/12/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHELE DURHAM, EXECUTIVE DIRECTOR
(210) 212-2266 Ext: 102
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
6/12/2023
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