Contract Pharmacy Details

AVITA PHARMACY 1035
HV06021B VALLEY AIDS COUNCIL

Covered Entity Details

Entity Name

VALLEY AIDS COUNCIL

Subdivision Name

Type

Ryan White Part C

340B ID

HV06021B

Entity Address

300 S. 2nd St
SUITE C
MCALLEN, TX 78501

Grant Number

H76HA00131

Participating Start Date

7/1/2009

Last Recertification Date

2/21/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1035

Pharmacy Address

101 W KOENIG LN, STE 400
AUSTIN, TX 78751

Pharmacy Comments

Contract Details

Approval Date

4/15/2025

Contract Begin Date

7/1/2025

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Wally Cantu, Executive Director
(956) 428-2653

Contract Pharmacy Representative

Avita
Chris Creamer, COO
(469) 592-2000

Signed By Date

4/15/2025