340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1040
CH04023F AGAPE COMMUNITY HEALTH CENTER, INC.
Print
Covered Entity Details
Entity Name
AGAPE COMMUNITY HEALTH CENTER, INC.
Subdivision Name
AGAPE/WEST JACKSONVILLE COMMUNITY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH04023F
Entity Address
120 King Street
JACKSONVILLE, FL 32204-2410
Grant Number
H80CS29456
Participating Start Date
4/1/2003
Last Recertification Date
2/21/2025
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
10/5/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mia Jones, CEO
(904) 703-0165
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
10/5/2016
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