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AVITA PHARMACY 1029
RWI70112 THE ADMINISTRATORS OF THE TULANE EDUCATIONAL FUND
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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 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
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
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