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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD33130 Survivors Pathway Corporation
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Covered Entity Details
Entity Name
Survivors Pathway Corporation
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33130
Entity Address
33 sw 2nd ave
ste 901
miami, FL 33130
Grant Number
NH25PS005131
Participating Start Date
8/18/2023
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
10/2/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Francesco Duberli, Chief Executive Officer
(305) 299-1957
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/2/2023
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