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AVITA PHARMACY 1028
CHC28964-03 START CORPORATION
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Covered Entity Details
Entity Name
START CORPORATION
Subdivision Name
Start CHC- Covington
Type
HRSA-Funded Health Center
340B ID
CHC28964-03
Entity Address
1505 North Florida St.
Covington, LA 70433-1544
Grant Number
H80CS28964
Participating Start Date
4/1/2019
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
10/9/2019
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
10/9/2019
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