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AVITA PHARMACY 1040
CH040490 CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
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Covered Entity Details
Entity Name
CURTIS V. COOPER PRIMARY HEALTH CARE, INC.
Subdivision Name
FORMERLY WESTSIDE URBAN HLTH CTRS, INC.
Type
HRSA-Funded Health Center
340B ID
CH040490
Entity Address
106 EAST BROAD STREET
SAVANNAH, GA 31401
Grant Number
H80CS00082
Participating Start Date
12/1/1992
Last Recertification Date
2/17/2025
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
10/15/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Albert B. Grandy JR., CEO
(912) 527-1117
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/15/2019
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