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AVITA PHARMACY 1038
STD79902 Southwest Viral Med
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Covered Entity Details
Entity Name
Southwest Viral Med
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD79902
Entity Address
1201 East Schuster Avenue, Building 7
El Paso, TX 79902
Grant Number
NH25PS005182
Participating Start Date
10/1/2017
Last Recertification Date
5/27/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1038
Pharmacy Address
AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM
3308 TULANE AVE STE 102
NEW ORLEANS, LA 70119-7170
Pharmacy Comments
Contract Details
Approval Date
8/8/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/31/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Ogechika Alozie, Chief Executive Officer
(915) 229-6448
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, FOUNDER
(504) 905-4587
Signed By Date
8/8/2017
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