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AVITA PHARMACY 1029
CH063710 SOUTHEAST COMMUNITY HEALTH SYSTEMS
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Covered Entity Details
Entity Name
SOUTHEAST COMMUNITY HEALTH SYSTEMS
Subdivision Name
Southeast Community Health Systems - Greensburg Location
Type
HRSA-Funded Health Center
340B ID
CH063710
Entity Address
490 SITMAN STREET
GREENSBURG, LA 70441-1207
Grant Number
H80CS00370
Participating Start Date
4/1/1999
Last Recertification Date
2/14/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
10/17/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/22/2021
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Alecia Cyprian, Chief Executive Officer
(225) 306-2010
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
10/17/2016
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