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AVITA PHARMACY 1037
CH040780 DELTA HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
DELTA HEALTH CENTER, INC.
Subdivision Name
DELTA HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH040780
Entity Address
702 MARTIN L. KING ROAD
MOUND BAYOU, MS 38762-0900
Grant Number
H80CS00085
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1037
Pharmacy Address
AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC
2519 CANAL ST
NEW ORLEANS, LA 70119
Pharmacy Comments
Contract Details
Approval Date
7/26/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John A. Fairman, CEO
(662) 741-8880
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/26/2018
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