Contract Pharmacy Details

AVITA PHARMACY 1038
RWI70119 NO/AIDS Task Force d.b.a. CrescentCare

Covered Entity Details

Entity Name

NO/AIDS Task Force d.b.a. CrescentCare

Subdivision Name

CrescentCare - St. Roch

Type

Ryan White Part A

340B ID

RWI70119

Entity Address

1631 ELYSIAN FIELDS AVE
NEW ORLEANS, LA 70117

Grant Number

H89HA00035

Participating Start Date

7/1/2001

Last Recertification Date

3/7/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1038

Pharmacy Address

AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM
3308 TULANE AVE STE 102
NEW ORLEANS, LA 70119-7170

Pharmacy Comments

Contract Details

Approval Date

3/29/2016

Contract Begin Date

4/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

FRAN LAWLESS, DIRECTOR OFFICE OF HEALTH POLICY & AIDS
(504) 658-2804

Contract Pharmacy Representative

Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587

Signed By Date

3/29/2016

340B Drug Pricing Program Database