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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD336113 PREVENTION 305, Inc.
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Covered Entity Details
Entity Name
PREVENTION 305, Inc.
Subdivision Name
PREVENTION 813
Type
Sexually Transmitted Diseases
340B ID
STD336113
Entity Address
3317 West Gandy Blvd
Tampa, FL 33611
Grant Number
NH25PS005131
Participating Start Date
4/1/2024
Last Recertification Date
5/9/2025
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
2/5/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Patrick Whiteside, Chief Executive Officer
(866) 773-7305 Ext: 100
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/16/2024
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