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AVITA PHARMACY 1047
Sunshine Specialty Health Outreach Foundation
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Covered Entity Details
Entity Name
Sunshine Specialty Health Outreach Foundation
Subdivision Name
Sunshine Specialty Health Care
Type
Sexually Transmitted Diseases
340B ID
Entity Address
1727 Orlando Central Pkwy
ORLANDO, FL 32809
Grant Number
5NU62PS9224532-02
Participating Start Date
Last Recertification Date
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1047
Pharmacy Address
AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR
801 N MAGNOLIA AVE STE 406
ORLANDO, FL 32803-3843
Pharmacy Comments
Contract Details
Approval Date
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jillian Hall, President
(407) 325-1299
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/14/2025
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