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AVITA PHARMACY 1044
CHC33642-02 AIDS Action Coalition of Huntsville
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Covered Entity Details
Entity Name
AIDS Action Coalition of Huntsville
Subdivision Name
Thrive Behavioral Health - Church Street
Type
HRSA-Funded Health Center
340B ID
CHC33642-02
Entity Address
415E Church St NW
Ste 10
Huntsville, AL 35801
Grant Number
H80CS33642
Participating Start Date
1/1/2020
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1044
Pharmacy Address
AVITA DRUGS ALABAMA LLC D/B/A AVITA PHAR
3220 5TH AVE S STE 110
BIRMINGHAM, AL 35222-2309
Pharmacy Comments
Contract Details
Approval Date
1/10/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary Elizabeth Marr, CEO
(256) 337-8283
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/10/2020
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