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AVITA PHARMACY 1034
STD752074 DALLAS COUNTY HEALTH AND HUMAN SERVICES
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Covered Entity Details
Entity Name
DALLAS COUNTY HEALTH AND HUMAN SERVICES
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD752074
Entity Address
2377 N. STEMMONS FREEWAY
SUITE 100
DALLAS, TX 75207
Grant Number
NH25PS005182
Participating Start Date
1/1/1995
Last Recertification Date
5/19/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1034
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
2800 S IH-35 FRONTAGE RD.
STE 105
AUSTIN, TX 78704
Pharmacy Comments
Contract Details
Approval Date
10/5/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/6/2023
Agreement registered in error
Contacts
Covered Entity Signing Official
Philip Huang, Director
(214) 819-2014
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/5/2023
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