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AVITA PHARMACY 1047
STD336261 Harmony Healthcare Orlando, Inc
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Covered Entity Details
Entity Name
Harmony Healthcare Orlando, Inc
Subdivision Name
Harmony Healthcare, Inc
Type
Sexually Transmitted Diseases
340B ID
STD336261
Entity Address
13047 W. Linebaugh Ave
Suite 101
Tampa, FL 33626
Grant Number
NH25PS005131
Participating Start Date
7/1/2021
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1047
Pharmacy Address
AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR
1110 KEVSTIN DR
KISSIMMEE, FL 34744
Pharmacy Comments
Contract Details
Approval Date
4/15/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Priscilla Torres, Executive Director
(407) 777-2022
Contract Pharmacy Representative
Avita
Keith Fox, Senior VP National Accounts
(225) 315-8186
Signed By Date
4/15/2024
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