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AVITA PHARMACY 1040
STD331363 University of Miami PrEP Clinic
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Covered Entity Details
Entity Name
University of Miami PrEP Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD331363
Entity Address
1951 NW 7th avenue
Miami, FL 33136
Grant Number
NH25PS005131
Participating Start Date
10/1/2018
Last Recertification Date
5/24/2020
Entity Termination Date
10/1/2020
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
1/16/2020
Contract Begin Date
4/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/1/2020
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Susanne Doblecki-Lewis, Professor of Clinical Medicine and Chief, Division of Infectious Diseases
(305) 243-7652
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
1/16/2020
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