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AVITA PHARMACY 1039
CHC33653-03 Baptist Community Health Services, Inc.
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Covered Entity Details
Entity Name
Baptist Community Health Services, Inc.
Subdivision Name
Baptist Community Health Services- Upper 9th Ward
Type
HRSA-Funded Health Center
340B ID
CHC33653-03
Entity Address
4209 Saint Claude Ave
New Orleans, LA 70117-5338
Grant Number
H80CS33653
Participating Start Date
4/1/2020
Last Recertification Date
2/13/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1039
Pharmacy Address
1631 ELYSIAN FIELDS AVE STE 200
NEW ORLEANS, LA 70117-8208
Pharmacy Comments
Contract Details
Approval Date
2/28/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Shawn Powers, CEO
(682) 249-4128
Contract Pharmacy Representative
Avita Pharmacy Solution
mark Roth, Senior Account Executive
(504) 908-5932
Signed By Date
1/15/2020
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