340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1043
CH040780 DELTA HEALTH CENTER, INC.
Print
Covered Entity Details
Entity Name
DELTA HEALTH CENTER, INC.
Subdivision Name
DELTA HEALTH CENTER, INC.
Type
HRSA-Funded Health Center
340B ID
CH040780
Entity Address
702 MARTIN L. KING ROAD
MOUND BAYOU, MS 38762-0900
Grant Number
H80CS00085
Participating Start Date
12/1/1992
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1043
Pharmacy Address
AVITA DRUGS MISSISSIPPI LLC D/B/A AVITA
805 E RIVER PL STE A
JACKSON, MS 39202-3486
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
John A. Fairman, CEO
(662) 741-8880
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
10/15/2019
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session