Contract Pharmacy Details

AVITA PHARMACY 1082
STD78550 Valley AIDS Council

Covered Entity Details

Entity Name

Valley AIDS Council

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD78550

Entity Address

2306 Camelot Plaza Circle
Harlingen, TX 78550-8407

Grant Number

NU62PS924529

Participating Start Date

1/1/2017

Last Recertification Date

5/13/2025

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

Wally Cantu, Executive Director
(956) 428-2653

Contract Pharmacy Representative

Avita
Chris Creamer, COO
(469) 592-2000

Signed By Date

7/12/2024