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AVITA PHARMACY 1044
STD35630 AIDS Action Coalition of Huntsville
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Covered Entity Details
Entity Name
AIDS Action Coalition of Huntsville
Subdivision Name
Thrive Alabama
Type
Sexually Transmitted Diseases
340B ID
STD35630
Entity Address
112 South Pine St
Florence, AL 35630
Grant Number
5 NH25PS005129-05-00
Participating Start Date
4/1/2017
Last Recertification Date
5/5/2025
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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