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AVITA PHARMACY 1040
West Alabama AIDS Outreach dba Five Horizons Health Services
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach dba Five Horizons Health Services
Subdivision Name
Oxford
Type
Ryan White Part B
340B ID
Entity Address
2890 South Lamar Blvd
Oxford, MS 38655
Grant Number
X07HA00036
Participating Start Date
Last Recertification Date
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Will Rainer, Chief Compliance Officer
(659) 734-2319
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/15/2025
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