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AVITA PHARMACY 1040
CHC12885-03 HOUSTON AREA COMMUNITY SERVICES, INC
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Covered Entity Details
Entity Name
HOUSTON AREA COMMUNITY SERVICES, INC
Subdivision Name
HACS: Main Campus
Type
HRSA-Funded Health Center
340B ID
CHC12885-03
Entity Address
2150 W 18th St
Houston, TX 77008-5200
Grant Number
H80CS12885
Participating Start Date
4/1/2015
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
7/15/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/30/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Joe C. Fuentes, CEO
(713) 426-0027
Contract Pharmacy Representative
Avita Drugs
Mark Roth, Account Manager
(504) 908-5932
Signed By Date
7/15/2016
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