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AVITA PHARMACY 1029
STD78207 Alamo Area Resource Center
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Covered Entity Details
Entity Name
Alamo Area Resource Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78207
Entity Address
303 N. Frio St.
San Antonio, TX 78207
Grant Number
NH25PS005182
Participating Start Date
1/1/2017
Last Recertification Date
5/5/2025
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
10/27/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
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