Contract Pharmacy Details

AVITA PHARMACY 1035
FP785503 Valley AIDS Council

Covered Entity Details

Entity Name

Valley AIDS Council

Subdivision Name

Type

Family Planning (Title X only)

340B ID

FP785503

Entity Address

2306 Camelot Plaza Circle
Harlingen, TX 78550

Grant Number

FPHPA006401

Participating Start Date

4/1/2020

Last Recertification Date

5/14/2025

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

Lizette M Saenz, COO
(956) 428-2653

Contract Pharmacy Representative

Avita
Chris Creamer, COO
(469) 592-2000

Signed By Date

4/15/2025