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AVITA PHARMACY 1029
STD35233 BIRMINGHAM AIDS OUTREACH INC.
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Covered Entity Details
Entity Name
BIRMINGHAM AIDS OUTREACH INC.
Subdivision Name
Magic City Wellness Center
Type
Sexually Transmitted Diseases
340B ID
STD35233
Entity Address
3220 5th Avenue South
Suite 100
Birmingham, AL 35222
Grant Number
5 NH25PS005129-04
Participating Start Date
1/1/2017
Last Recertification Date
5/13/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
10/14/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KAREN MUSGROVE, EXECUTIVE DIRECTOR
(205) 322-4197
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
10/14/2024
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