Contract Pharmacy Details

AVITA PHARMACY 1082
STD78520 Valley AIDS Council

Covered Entity Details

Entity Name

Valley AIDS Council

Subdivision Name

Type

Sexually Transmitted Diseases

340B ID

STD78520

Entity Address

857 E Washington
Brownsville, TX 78520

Grant Number

NU62PS924529

Participating Start Date

1/1/2020

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