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AVITA PHARMACY 1044
RWII352223A AIDS Alabama, Inc.
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Covered Entity Details
Entity Name
AIDS Alabama, Inc.
Subdivision Name
The HUB
Type
Ryan White Part B
340B ID
RWII352223A
Entity Address
2217 6th Avenue South
Birmingham, AL 35233
Grant Number
X07HA00049
Participating Start Date
10/1/2019
Last Recertification Date
2/6/2020
Entity Termination Date
4/1/2021
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Kathie Hiers, Chief Executive Officer
(205) 324-9822
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/14/2020
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