No
| Contract Detail | AVITA PHARMACY 1040 | AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 |
6100 CORPORATE BLVD STE 250
| BATON ROUGE | LA | 70808 | 07/26/2022 | 10/01/2022 | | | 10/01/2022 |
| Contract Detail | AVITA PHARMACY 1058 | MEDEXPRESS PHARMACY, LTD. DBA AVITA PHAR |
1431 W. INNES ST.
| SALISBURY | NC | 28144 | 04/02/2025 | 07/01/2025 | | | 04/02/2025 |
| Contract Detail | LONGS DRUGS OF LEXINGTON | D/B/A AVITA PHARMACY 1051 |
1216 W MAIN ST
STE D
| LEXINGTON | SC | 29072-2453 | 07/26/2022 | 10/01/2022 | | | 10/01/2022 |
| Contract Detail | MUSC MAIL ORDER PHARMACY | MARVA WILLIAMS-LOWE, PHARMD |
2070 SAM RITTENBERG BLVD UNIT A116
| CHARLESTON | SC | 29407 | 07/26/2022 | 10/01/2022 | | 10/06/2023 | 10/07/2023 |
| Contract Detail | MUSC RUTLEDGE TOWER AMB PHARMACY | MARVA WILLIAMS-LOWE, PHARMD |
135 RUTLEDGE AVE
RM 106, MSC 584
| CHARLESTON | SC | 29425 | 07/26/2022 | 10/01/2022 | | 10/06/2023 | 10/07/2023 |
| Details | Last Recertification Date | Update | Recertification | 1/29/2024 3:38:51 PM | 2/11/2025 9:01:07 AM | 2/11/2025 9:01 AM |
| Addresses | Shipping Address | Delete | Change Request | Medical University of South Carolina
135 Rutledge Ave
MSC 752
Charleston, SC 29425 | | 2/5/2024 12:38 PM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2023 1:31:30 PM | 1/29/2024 3:38:51 PM | 1/29/2024 3:38 PM |
| Details | NOFO Number | Update | | HRSA-22-033 | | 12/16/2023 10:34 AM |
| Details | Assistance Received To Date | Update | Recertification | 3/31/2025 12:00:00 AM | 3/31/2027 12:00:00 AM | 2/17/2023 1:31 PM |
| Details | Last Recertification Date | Update | Recertification | | 2/17/2023 1:31:30 PM | 2/17/2023 1:31 PM |
| Details | NOFO Number | Update | Recertification | HRSA-17-036 | HRSA-22-033 | 2/17/2023 1:31 PM |
| Details | State | Update | | Approved | Active | 10/1/2022 12:01 AM |
| Contacts | Authorizing Official | Update | New Registration | Anderson, Richard Lynn
Executive Vice President for Finance and Operations
MUSC
8437925050 | Anderson, Richard Lynn
Executive Vice President for Finance and Operations
Medical University of South Carolina
8437925050 | 7/26/2022 10:16 AM |
| Contacts | Signed By | Insert | New Registration | | Anderson, Richard Lynn
Executive Vice President for Finance and Operations
Medical University of South Carolina
8437925050 | 7/26/2022 10:16 AM |
| Details | 340B ID | Update | New Registration | | RWII29425B | 7/26/2022 10:16 AM |
| Dates | Participating Approval Date | Update | New Registration | | 7/26/2022 10:16:54 AM | 7/26/2022 10:16 AM |
| Details | State | Update | New Registration | Pending | Approved | 7/26/2022 10:16 AM |
| Dates | Signed By Date | Update | New Registration | | 7/14/2022 3:19:34 PM | 7/26/2022 10:16 AM |
| Dates | Start Date | Update | New Registration | | 10/1/2022 12:00:00 AM | 7/26/2022 10:16 AM |
| Addresses | Main Address | Insert | New Registration | |
2250 Mall Dr
North Charleston, SC 29406 | 7/6/2022 1:04 PM |
| Addresses | Billing Address | Insert | New Registration | | Medical University of South Carolina
135 Rutledge Ave
MSC 752
Charleston, SC 29425 | 7/6/2022 1:04 PM |
| Addresses | Shipping Address | Insert | New Registration | | Medical University of South Carolina
135 Rutledge Ave
MSC 752
Charleston, SC 29425 | 7/6/2022 1:04 PM |
| Contacts | Primary Contact | Insert | New Registration | | Ohorodnyk, Megan
Ryan White Program Coordinator
MUSC
8437927485 | 7/6/2022 1:04 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Anderson, Richard Lynn
Executive Vice President for Finance and Operations
MUSC
8437925050 | 7/6/2022 1:04 PM |
| Details | Assistance Received From Date | Insert | New Registration | | 4/1/2022 12:00:00 AM | 7/6/2022 1:04 PM |
| Details | Assistance Received To Date | Insert | New Registration | | 3/31/2025 12:00:00 AM | 7/6/2022 1:04 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Details | Grant Number | Insert | New Registration | | X07HA00038 | 7/6/2022 1:04 PM |
| Details | 340B ID | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Details | Entity Name | Insert | New Registration | | Medical University of SC Infectious Disease Ryan White Program | 7/6/2022 1:04 PM |
| Details | NOFO Number | Insert | New Registration | | HRSA-17-036 | 7/6/2022 1:04 PM |
| Details | Program Code | Insert | New Registration | | RWII | 7/6/2022 1:04 PM |
| Details | Entity Subname | Insert | New Registration | | MUSC Ryan White Program | 7/6/2022 1:04 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Details | State | Insert | New Registration | | Pending | 7/6/2022 1:04 PM |
| Dates | Registration Date | Insert | New Registration | | 7/6/2022 1:04:31 PM | 7/6/2022 1:04 PM |
| Dates | Signed By Date | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Dates | Start Date | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Terminations | Termination Date | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 7/6/2022 1:04 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 7/6/2022 1:04 PM |