340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1028
DSH450213H UNIVERSITY HEALTH SYSTEM
Print
Covered Entity Details
Entity Name
UNIVERSITY HEALTH SYSTEM
Subdivision Name
Robert B. Green Campus FFACTS
Type
Disproportionate Share Hospital
340B ID
DSH450213H
Entity Address
903 W Martin St
San Antonio, TX 78207
Medicare Provider Number
450213
Outpatient Facility Provider Number
Participating Start Date
7/1/2004
Last Recertification Date
9/10/2024
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
9/19/2012
Contract Begin Date
9/19/2012
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
MARY ANN MOTE, CHIEF REVENUE OFFICER
(210) 358-2895
Contract Pharmacy Representative
Avita Drugs
KEITH FOX, CFO
(225) 236-1540
Signed By Date
8/31/2012
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session