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AVITA PHARMACY 1035
RWI78212 BEAT AIDS COALITION TRUST
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Covered Entity Details
Entity Name
BEAT AIDS COALITION TRUST
Subdivision Name
Type
Ryan White Part A
340B ID
RWI78212
Entity Address
208 W EUCLID AVE
SAN ANTONIO, TX 78212
Grant Number
H89HA31891
Participating Start Date
1/1/2017
Last Recertification Date
2/15/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1035
Pharmacy Address
101 W KOENIG LN, STE 400
AUSTIN, TX 78751
Pharmacy Comments
Contract Details
Approval Date
4/11/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHELE DURHAM, EXECUTIVE DIRECTOR
(210) 212-2266 Ext: 102
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/11/2025
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