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AVITA PHARMACY 1029
STD787021 CHE Center for Health Empowerment
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Covered Entity Details
Entity Name
CHE Center for Health Empowerment
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD787021
Entity Address
2312 Western Trails Blvd
Ste 103
Austin, TX 78745
Grant Number
NH25PS005182
Participating Start Date
7/1/2017
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
7/11/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Byron Marshall, CEO
(512) 236-1925
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
7/11/2017
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