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AVITA PHARMACY 1040
STD328062 Bliss Cares
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Covered Entity Details
Entity Name
Bliss Cares
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD328062
Entity Address
3901 E Colonial Drive
ORLANDO, FL 32803
Grant Number
NH25PS005131
Participating Start Date
7/1/2016
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Juan Rodriguez, Executive Director
(407) 761-3361
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
10/15/2018
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