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AVITA PHARMACY 1044
STD35222 AIDS Alabama, Inc.
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Covered Entity Details
Entity Name
AIDS Alabama, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD35222
Entity Address
3529 7th Avenue South
Birmingham, AL 35222
Grant Number
5NH25PS005129-03-00
Participating Start Date
7/1/2017
Last Recertification Date
5/6/2025
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
4/14/2020
Contract Begin Date
7/1/2020
Carve-In Effective Date
Contract Comments
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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