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AVITA PHARMACY 1030
CHC26587-01 SAINT HOPE FOUNDATION
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Covered Entity Details
Entity Name
SAINT HOPE FOUNDATION
Subdivision Name
St. Hope Community Health Center-Sugar Land
Type
HRSA-Funded Health Center
340B ID
CHC26587-01
Entity Address
14815 Southwest Fwy
Sugar Land, TX 77478
Grant Number
H80CS26587
Participating Start Date
7/1/2017
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1030
Pharmacy Address
6800 WEST LOOP S STE 225
BELLAIRE, TX 77401
Pharmacy Comments
Contract Details
Approval Date
4/17/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timika Sam-Cooper, Chief Operations Officer
(713) 778-1300 Ext: 2342
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
4/17/2017
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