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AVITA PHARMACY 1029
RWII79902 Southwest Viral Med
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Covered Entity Details
Entity Name
Southwest Viral Med
Subdivision Name
Type
Ryan White Part B
340B ID
RWII79902
Entity Address
1201 East Schuster Avenue, Building 7
El Paso, TX 79902
Grant Number
X07HA00054
Participating Start Date
4/1/2015
Last Recertification Date
2/22/2025
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
1/14/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ogechika Alozie, President
(915) 222-1300
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
1/14/2016
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