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AVITA PHARMACY 1043
West Alabama AIDS Outreach
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Covered Entity Details
Entity Name
West Alabama AIDS Outreach
Subdivision Name
Five Horizons Health Services
Type
Sexually Transmitted Diseases
340B ID
Entity Address
2890 South Lamar Blvd
Oxford, MS 38655
Grant Number
NH25PS005147
Participating Start Date
Last Recertification Date
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1043
Pharmacy Address
AVITA DRUGS MISSISSIPPI LLC D/B/A AVITA
805 E RIVER PL STE A
JACKSON, MS 39202-3486
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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