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AVITA PHARMACY 1044
RWII36609 AIDS Alabama South, LLC
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Covered Entity Details
Entity Name
AIDS Alabama South, LLC
Subdivision Name
Type
Ryan White Part B
340B ID
RWII36609
Entity Address
4321 Downtowner Loop North
Mobile, AL 36609
Grant Number
X07HA00049
Participating Start Date
10/1/2017
Last Recertification Date
2/13/2025
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
4/13/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Lanita Khalil, Executive Director
(251) 545-4665
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/13/2020
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