Contract Pharmacy Details

AVITA PHARMACY 1082
FP785503 Valley AIDS Council

Covered Entity Details

Entity Name

Valley AIDS Council

Subdivision Name

Type

Family Planning (Title X only)

340B ID

FP785503

Entity Address

2306 Camelot Plaza Circle
Harlingen, TX 78550

Grant Number

FPHPA006401

Participating Start Date

4/1/2020

Last Recertification Date

5/14/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1082

Pharmacy Address

2306 CAMELOT PLAZA CIR STE B
HARLINGEN, TX 78550

Pharmacy Comments

Contract Details

Approval Date

7/12/2024

Contract Begin Date

10/1/2024

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Lizette M Saenz, COO
(956) 428-2653

Contract Pharmacy Representative

Avita
Chris Creamer, COO
(469) 592-2000

Signed By Date

7/12/2024