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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD338441 Diversity Healthcare
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Covered Entity Details
Entity Name
Diversity Healthcare
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD338441
Entity Address
1011 E Main St Suite A
Haines City, FL 33844
Grant Number
NH25PS005131
Participating Start Date
7/1/2024
Last Recertification Date
5/5/2025
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
6/5/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Clayton Dale Reedy, Owner/Provider
(937) 307-7891
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
6/5/2024
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