340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1047
CH04023G AGAPE COMMUNITY HEALTH CENTER, INC.
Print
Covered Entity Details
Entity Name
AGAPE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
AGAPE/Wesconnett Community Health Center
Type
HRSA-Funded Health Center
340B ID
CH04023G
Entity Address
5460 Blanding Blvd
Jacksonville, FL 32244
Grant Number
H80CS29456
Participating Start Date
10/1/2016
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1047
Pharmacy Address
AVITA DRUGS FLORIDA LLC D/B/A AVITA PHAR
801 N MAGNOLIA AVE STE 406
ORLANDO, FL 32803-3843
Pharmacy Comments
Contract Details
Approval Date
4/12/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mia L. Jones, CEO
(904) 760-4910
Contract Pharmacy Representative
Avita Pharmacy
Roland Hewitt, Account Executive
(407) 866-3283
Signed By Date
4/12/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session