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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD331272 Pridelines Youth Services, Inc.
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Covered Entity Details
Entity Name
Pridelines Youth Services, Inc.
Subdivision Name
Pridelines
Type
Sexually Transmitted Diseases
340B ID
STD331272
Entity Address
5525 NW 7th Ave
Miami, FL 33127
Grant Number
NU62PS924532
Participating Start Date
7/1/2024
Last Recertification Date
5/21/2025
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
5/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Edward Summers, Executive Director
(347) 468-6621
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/11/2024
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