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AVITA PHARMACY 1036
STD75234 Center for Health Empowerment
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Covered Entity Details
Entity Name
Center for Health Empowerment
Subdivision Name
Center for Health Empowerment Dallas County
Type
Sexually Transmitted Diseases
340B ID
STD75234
Entity Address
951 York Drive
Ste 102
DeSoto, TX 75115
Grant Number
NH25PS005182
Participating Start Date
7/1/2019
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1036
Pharmacy Address
3100 RED RIVER ST STE 3A
AUSTIN, TX 78705
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
Scott Lyles, President & CEO
(512) 608-7298
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/15/2024
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