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AVITA PHARMACY 1039
STD701153 Hope Clinic at the New Orleans Family Justice Center
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Covered Entity Details
Entity Name
Hope Clinic at the New Orleans Family Justice Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD701153
Entity Address
701 Loyola Avenue
Suite 108
New Orleans, LA 70113
Grant Number
NH25PS005176
Participating Start Date
10/1/2023
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1039
Pharmacy Address
1631 ELYSIAN FIELDS AVE STE 200
NEW ORLEANS, LA 70117-8208
Pharmacy Comments
Contract Details
Approval Date
7/24/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Mary Claire Landry, Executive Director
(504) 388-9281
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/11/2019
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