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AVITA PHARMACY 1040
CHC28964-01 START CORPORATION
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Covered Entity Details
Entity Name
START CORPORATION
Subdivision Name
Theodore Duhe Center
Type
HRSA-Funded Health Center
340B ID
CHC28964-01
Entity Address
235 Civic Center Blvd
Houma, LA 70360-5937
Grant Number
H80CS28964
Participating Start Date
7/1/2018
Last Recertification Date
2/12/2025
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
10/8/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Catherine Broussard, QA/Compliance Officer
(985) 333-2020 Ext: 2005
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
10/8/2019
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