340B Drug Pricing Program Database

Pharmacy Name

AVITA PHARMACY 1030

Pharmacy Address

6800 WEST LOOP S STE 225
BELLAIRE, TX 77401

Pharmacy Comments

Approval Date

4/6/2018

Contract Begin Date

7/1/2018

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Timika Sam-Cooper, Chief Operations Officer
(713) 778-1300 Ext: 2342

Contract Pharmacy Representative

Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587

Signed By Date

4/6/2018