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AVITA PHARMACY 1028
STD32803 26Health, Inc.
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Covered Entity Details
Entity Name
26Health, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD32803
Entity Address
801 N. Magnolia Ave., Ste 402
Orlando, FL 32803
Grant Number
NH25PS005131
Participating Start Date
10/5/2023
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
10/11/2017
Contract Begin Date
1/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/6/2018
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
David Baker-Hargrove, President/Co-CEO
(321) 800-2922
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/11/2017
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