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AVITA PHARMACY 1028
STD752151 Abounding Prosperity, Inc.
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Covered Entity Details
Entity Name
Abounding Prosperity, Inc.
Subdivision Name
HOPE Health Center
Type
Sexually Transmitted Diseases
340B ID
STD752151
Entity Address
Abounding Prosperity, Inc HOPE Health Center
1619 Martin Luther King Jr. Blvd
Dallas, TX 75215
Grant Number
NU62PS924529
Participating Start Date
10/1/2017
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
7/26/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Moyle, Nurse Practitioner (only monitor 340b database on behalf of CEO Tamara Stephney))
(469) 213-9593
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/26/2017
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