Contract Pharmacy Details

AVITA PHARMACY 1039
RWI70112 THE ADMINISTRATORS OF THE TULANE EDUCATIONAL FUND

Covered Entity Details

Entity Name

THE ADMINISTRATORS OF THE TULANE EDUCATIONAL FUND

Subdivision Name

TULANE TOTAL HEALTH CLINIC

Type

Ryan White Part A

340B ID

RWI70112

Entity Address

711 North Broad Street
New Orleans, LA 70119

Grant Number

H89HA00035

Participating Start Date

7/1/2018

Last Recertification Date

2/12/2025

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

7/8/2020

Contract Begin Date

10/1/2020

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

FRAN LAWLESS, DIRECTOR OFFICE OF HEALTH POLICY & AIDS
(504) 658-2804

Contract Pharmacy Representative

AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587

Signed By Date

7/8/2020

340B Drug Pricing Program Database