Contract Pharmacy Details

AVITA PHARMACY 1030
RWII70 VALLEY AIDS COUNCIL

Covered Entity Details

Entity Name

VALLEY AIDS COUNCIL

Subdivision Name

Type

Ryan White Part B

340B ID

RWII70

Entity Address

2306 CAMELOT PLAZA CIRCLE
HARLINGEN, TX 78550

Grant Number

X07HA00054

Participating Start Date

12/1/1992

Last Recertification Date

3/4/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1030

Pharmacy Address

6800 WEST LOOP S STE 225
BELLAIRE, TX 77401

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