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AVITA PHARMACY 1058
STD78754 The Wright House Wellness Center DBA ASHWELL
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Covered Entity Details
Entity Name
The Wright House Wellness Center DBA ASHWELL
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD78754
Entity Address
3100 Red River St.
STE 3
Austin, TX 78705
Grant Number
NH25PS005182
Participating Start Date
7/1/2018
Last Recertification Date
5/14/2024
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1058
Pharmacy Address
MEDEXPRESS PHARMACY, LTD. DBA AVITA PHAR
1431 W. INNES ST.
SALISBURY, NC 28144
Pharmacy Comments
Contract Details
Approval Date
5/3/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lauren Potter, Executive Director
(512) 467-0088
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
4/16/2018
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