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AVITA PHARMACY 1029
RWII29646 UPPER SAVANNAH CARE SERVICES
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Covered Entity Details
Entity Name
UPPER SAVANNAH CARE SERVICES
Subdivision Name
Type
Ryan White Part B
340B ID
RWII29646
Entity Address
108 Venture Ct.
GREENWOOD, SC 29649
Grant Number
X07HA00038
Participating Start Date
1/1/2011
Last Recertification Date
2/11/2025
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
10/27/2014
Contract Begin Date
1/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Roshan McDaniel, SC ADAP Director
(803) 898-0703
Contract Pharmacy Representative
Avita
Veleria Levy, Senior Account Executive
(704) 550-1900
Signed By Date
10/27/2014
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