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AVITA PHARMACY 1040
CH044130 MIAMI BEACH COMMUNITY HEALTH CENTER INC.
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Covered Entity Details
Entity Name
MIAMI BEACH COMMUNITY HEALTH CENTER INC.
Subdivision Name
MIAMI BEACH COMMUNITY HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH044130
Entity Address
710 Alton Rd
Miami Beach, FL 33139
Grant Number
H80CS00182
Participating Start Date
12/1/1992
Last Recertification Date
2/21/2025
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
1/16/2019
Contract Begin Date
4/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Rabinowitz, CEO
(305) 538-8835 Ext: 1600
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
1/16/2019
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