Contract Pharmacy Details

AVITA PHARMACY 1082
HV060210 VALLEY AIDS COUNCIL

Covered Entity Details

Entity Name

VALLEY AIDS COUNCIL

Subdivision Name

Type

Ryan White Part C

340B ID

HV060210

Entity Address

2306 Camelot Plaza Circle
HARLINGEN, TX 78550

Grant Number

H76HA00131

Participating Start Date

1/1/1998

Last Recertification Date

2/27/2025

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