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AVITA PHARMACY 1040
CHC28964-02 START CORPORATION
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Covered Entity Details
Entity Name
START CORPORATION
Subdivision Name
Start CHC- New Orleans
Type
HRSA-Funded Health Center
340B ID
CHC28964-02
Entity Address
701 Loyola Ave
New Orleans, LA 70113-1912
Grant Number
H80CS28964
Participating Start Date
4/1/2019
Last Recertification Date
2/16/2024
Entity Termination Date
1/1/2025
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
10/9/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
1/1/2025
Covered Entity Terminated
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
10/9/2019
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