No
| Contract Detail | AVITA PHARMACY 1040 | AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10 |
6100 CORPORATE BLVD STE 250
| BATON ROUGE | LA | 70808 | 08/05/2024 | 10/01/2024 | | | 10/01/2024 |
| Contract Detail | AVITA PHARMACY 1043 | AVITA DRUGS MISSISSIPPI LLC D/B/A AVITA |
805 E RIVER PL STE A
| JACKSON | MS | 39202-3486 | 08/05/2024 | 10/01/2024 | | | 10/01/2024 |
| Contract Detail | ICARE RX LLC | 14447 COUNTRY WALK DR |
| MIAMI | FL | 33186 | 06/06/2023 | 07/01/2023 | | 07/01/2024 | 07/01/2024 |
| Contract Detail | LONGS DRUGS OF LEXINGTON | D/B/A AVITA PHARMACY 1051 |
1216 W MAIN ST
STE D
| LEXINGTON | SC | 29072-2453 | 08/05/2024 | 10/01/2024 | | | 10/01/2024 |
| Contract Detail | PHARMBLUE LLC DBA AVITA PHARMACY 1059 | 1226 CHESTNUT ST |
| PHILADELPHIA | PA | 19107 | 08/05/2024 | 10/01/2024 | | | 10/01/2024 |
| Contract Detail | PHYSICIAN'S RX PHARMACY, LLC | PHYSICIANS RX PHARMACY, LLC |
9701 APOLLO DRIVE
#400
| LARGO | MD | 20774 | 06/06/2023 | 07/01/2023 | | 07/01/2024 | 07/01/2024 |
| Contract Detail | PRXP OF CA LLC | PRXP OF CA LLC |
4345 E LOWELL ST
STE C & D
| ONTARIO | CA | 91761 | 06/06/2023 | 07/01/2023 | | 07/01/2024 | 07/01/2024 |
| Contract Detail | PRXP OF NEW YORK LLC | DBA BROADWAY FAMILY PHARMACY |
601 AMSTERDAM AVE
| NEW YORK | NY | 10024 | 06/06/2023 | 07/01/2023 | | 07/01/2024 | 07/01/2024 |
| Details | State | Update | | Approved | Active | 10/1/2024 12:01 AM |
| Addresses | Main Address | Insert | Reinstatement | |
1385 E. Reed Rd
Suite B
Greenville, MS 38703 | 8/5/2024 7:47 AM |
| Details | Nature of Support: Support Received To Date | Update | Reinstatement | 7/31/2023 12:00:00 AM | 7/31/2024 12:00:00 AM | 8/5/2024 7:47 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Reinstatement | 6/30/2024 12:00:00 AM | | 8/5/2024 7:47 AM |
| Dates | Participating Approval Date | Update | Reinstatement | 6/6/2023 4:25:30 PM | 8/5/2024 7:47:29 AM | 8/5/2024 7:47 AM |
| Details | State | Update | Reinstatement | Terminated | Approved | 8/5/2024 7:47 AM |
| Dates | Registration Date | Update | Reinstatement | 4/17/2023 7:52:17 PM | 7/1/2024 11:01:20 AM | 8/5/2024 7:47 AM |
| Dates | Signed By Date | Update | Reinstatement | 4/17/2023 7:52:21 PM | 7/1/2024 11:01:22 AM | 8/5/2024 7:47 AM |
| Dates | Start Date | Update | Reinstatement | 7/1/2023 12:00:00 AM | 10/1/2024 12:00:00 AM | 8/5/2024 7:47 AM |
| Terminations | Termination Date | Update | Reinstatement | 7/1/2024 12:00:00 AM | | 8/5/2024 7:47 AM |
| Terminations | Termination Effective Date | Update | Reinstatement | 7/1/2024 12:00:00 AM | | 8/5/2024 7:47 AM |
| Terminations | Termination Reason | Update | Reinstatement | Failure to recertify | | 8/5/2024 7:47 AM |
| Details | Comments Public | Insert | Reinstatement | | Participated starting 7/1/2023, Terminated 7/1/2024, Reinstated 10/1/2024 | 8/1/2024 3:15 PM |
| Details | State | Update | | To Be Terminated | Terminated | 7/1/2024 12:01 AM |
| Dates | Last Date That 340B Drugs Purchased | Update | Recertification | | 6/30/2024 12:00:00 AM | 6/10/2024 12:30 PM |
| Details | State | Update | Recertification | Active | To Be Terminated | 6/10/2024 12:30 PM |
| Terminations | Termination Date | Update | Recertification | | 7/1/2024 12:00:00 AM | 6/10/2024 12:30 PM |
| Terminations | Termination Effective Date | Update | Recertification | | 7/1/2024 12:00:00 AM | 6/10/2024 12:30 PM |
| Terminations | Termination Reason | Update | Recertification | | Failure to recertify | 6/10/2024 12:30 PM |
| Details | State | Update | | Approved | Active | 7/1/2023 12:01 AM |
| Contacts | Signed By | Insert | New Registration | | Sturdevant, Cedric
Executive Director
Community Health Prevention Intervention Education & Research (CH-PIER)
6627023544 | 6/6/2023 4:25 PM |
| Details | 340B ID | Update | New Registration | | STD38703 | 6/6/2023 4:25 PM |
| Dates | Participating Approval Date | Update | New Registration | | 6/6/2023 4:25:30 PM | 6/6/2023 4:25 PM |
| Details | State | Update | New Registration | Pending | Approved | 6/6/2023 4:25 PM |
| Dates | Signed By Date | Update | New Registration | | 4/17/2023 7:52:21 PM | 6/6/2023 4:25 PM |
| Dates | Start Date | Update | New Registration | | 7/1/2023 12:00:00 AM | 6/6/2023 4:25 PM |
| Addresses | Main Address | Insert | New Registration | |
1385 E. Reed Rd
Suite B
Greenville, MS 38703 | 4/17/2023 7:52 PM |
| Details | Nature of Support: In Kind Support Description | Insert | New Registration | | HIV Testing and Prevention | 4/17/2023 7:52 PM |
| Details | Nature Of Support | Insert | New Registration | | In-Kind products or services (see note below; must have been purchased with section 318 funds) | 4/17/2023 7:52 PM |
| Details | Nature of Support: Support Received From Date | Insert | New Registration | | 8/1/2022 12:00:00 AM | 4/17/2023 7:52 PM |
| Details | Nature of Support: Support Received To Date | Insert | New Registration | | 7/31/2023 12:00:00 AM | 4/17/2023 7:52 PM |
| Contacts | Authorizing Official | Insert | New Registration | | Sturdevant, Cedric
Executive Director
Community Health Prevention Intervention Education & Research (CH-PIER)
6627023544 | 4/17/2023 7:52 PM |
| Contacts | Primary Contact | Insert | New Registration | | Richardson, Ashley
Administrative Assistant
Community Health-PIER
6627023544 | 4/17/2023 7:52 PM |
| Details | Assistance Received From Date | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Details | Assistance Received To Date | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Details | Last Recertification Date | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Details | Grant Number | Insert | New Registration | | NU62PS924624 | 4/17/2023 7:52 PM |
| Details | 340B ID | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Details | Medicare Provider Number | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Details | Entity Name | Insert | New Registration | | Community Health Prevention Intervention Education & Research (CH-PIER) | 4/17/2023 7:52 PM |
| Details | NOFO Number | Insert | New Registration | | PS20-2010 | 4/17/2023 7:52 PM |
| Details | Program Code | Insert | New Registration | | STD | 4/17/2023 7:52 PM |
| Details | Entity Subname | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Dates | Participating Approval Date | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Details | State | Insert | New Registration | | Pending | 4/17/2023 7:52 PM |
| Dates | Registration Date | Insert | New Registration | | 4/17/2023 7:52:17 PM | 4/17/2023 7:52 PM |
| Dates | Signed By Date | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Dates | Start Date | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Terminations | Termination Comments | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Terminations | Termination Date | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Terminations | Termination Effective Date | Insert | New Registration | | | 4/17/2023 7:52 PM |
| Terminations | Termination Reason | Insert | New Registration | | | 4/17/2023 7:52 PM |