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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD333193 Lauderdale Health Foundation, INC
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Covered Entity Details
Entity Name
Lauderdale Health Foundation, INC
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD333193
Entity Address
4000 N. State Road 7
Suite 103
Lauderdale Lakes, FL 33319
Grant Number
NH25PS005131
Participating Start Date
1/1/2025
Last Recertification Date
5/19/2025
Pharmacy Details
Pharmacy Name
AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
Pharmacy Address
8601 COMMODITY CIR, SUITE 105
ORLANDO, FL 32819-9003
Pharmacy Comments
Contract Details
Approval Date
1/15/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jean Pierre, President
(305) 834-8585
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/15/2025
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