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AVITA PHARMACY 1028
CH061010 MARTIN LUTHER KING JR FAMILY CLINIC INC
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Covered Entity Details
Entity Name
MARTIN LUTHER KING JR FAMILY CLINIC INC
Subdivision Name
MARTIN LUTHER KING, JR. FAMILY CLINIC, INC. dba Foremost Family Health Centers
Type
HRSA-Funded Health Center
340B ID
CH061010
Entity Address
2922B Martin Luther King Jr Blvd
Dallas, TX 75215
Grant Number
H80CS00127
Participating Start Date
12/1/1992
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
JOYCE E. TAPLEY, CEO
(469) 601-9360
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/13/2023
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