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AVITA PHARMACY 1029
STD770021 AIDS Foundation Houston DBA/ Allies in Hope
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Covered Entity Details
Entity Name
AIDS Foundation Houston DBA/ Allies in Hope
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD770021
Entity Address
2328 Fannin St.
Houston, TX 77002
Grant Number
5NU62PS9246850400
Participating Start Date
6/22/2023
Last Recertification Date
5/14/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Campbell, Chief Executive Officer
(713) 623-6796 Ext: 244
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/10/2023
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