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AVITA PHARMACY 1029
HV00721 The Administrators of the Tulane Educational Fund
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Covered Entity Details
Entity Name
The Administrators of the Tulane Educational Fund
Subdivision Name
Tulane Doctors RW Clinic - Alexandria
Type
Ryan White Part C
340B ID
HV00721
Entity Address
1208 Wisteria Street
Alexandria, LA 71301
Grant Number
H76HA00721
Participating Start Date
10/1/2011
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
1/15/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KATHLEEN M. KOZAR, Director, Sponsored projects Administration
(504) 988-5207
Contract Pharmacy Representative
Avita Drugs
KEITH FOX, CFO
(225) 236-1540
Signed By Date
1/15/2020
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