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AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
CH06325AA El Centro Del Barrio
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Covered Entity Details
Entity Name
El Centro Del Barrio
Subdivision Name
CENTROMED FAMILY MEDICINE CLINIC
Type
HRSA-Funded Health Center
340B ID
CH06325AA
Entity Address
226 North Union Avenue
New Braunfels, TX 78130
Grant Number
H80CS00758
Participating Start Date
4/1/2019
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
Pharmacy Address
2602 N MAIN AVE
SAN ANTONIO, TX 78212
Pharmacy Comments
Contract Details
Approval Date
7/8/2024
Contract Begin Date
10/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ernesto Gomez, President / CEO
(210) 334-3703
Contract Pharmacy Representative
Avita
Taylor Stockett, Strategic Account Executive
(512) 804-8119
Signed By Date
7/8/2024
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