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AVITA DRUGS FLORIDA, LLC DBA AVITA PHARM
STD3280510 Helping Oppressed & Marginalized Communities to Elevate, Inc.
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Covered Entity Details
Entity Name
Helping Oppressed & Marginalized Communities to Elevate, Inc.
Subdivision Name
HOME - DT
Type
Sexually Transmitted Diseases
340B ID
STD3280510
Entity Address
750 South Orange Blossom Trail
#171
Orlando, FL 32805
Grant Number
H25PS005131
Participating Start Date
1/1/2025
Last Recertification Date
5/6/2025
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
Preston J Queenan, President
(484) 868-4948
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/15/2025
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