Contract Pharmacy Details

AVITA PHARMACY 1029
RWII77301 ST. HOPE FOUNDATION, INC.

Covered Entity Details

Entity Name

ST. HOPE FOUNDATION, INC.

Subdivision Name

Type

Ryan White Part B

340B ID

RWII77301

Entity Address

1414 SOUTH FRAZIER #105/106
CONROE, TX 77301

Grant Number

T2-TX

Participating Start Date

4/1/2009

Last Recertification Date

2/14/2020

Entity Termination Date

1/1/2021

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1029

Pharmacy Address

340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034

Pharmacy Comments

Contract Details

Approval Date

11/21/2009

Contract Begin Date

11/21/2009

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/1/2021
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Timika Sam-Cooper, Chief Operations Officer
(713) 778-1300 Ext: 2342

Contract Pharmacy Representative

MIKE MCBRIDE, DIRECTOR OF PHARMACY
(210) 231-0383

Signed By Date

10/21/2009

340B Drug Pricing Program Database