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AVITA DRUGS TENESSEE, LLC
STD372061 Music City PrEP Clinic
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Covered Entity Details
Entity Name
Music City PrEP Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD372061
Entity Address
225 S. 11th St
Ste 101A
Nashville, TN 37206
Grant Number
NH25PS005151
Participating Start Date
7/1/2019
Last Recertification Date
5/10/2024
Pharmacy Details
Pharmacy Name
AVITA DRUGS TENESSEE, LLC
Pharmacy Address
DBA AVITA PHARMACY 1050
806 S COOPER ST
STE A
MEMPHIS, TN 38104
Pharmacy Comments
Contract Details
Approval Date
7/11/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
3/24/2024
Pharmacy closed
Contacts
Covered Entity Signing Official
Richard Clark MacKinnon, Executive Director
(615) 469-1065
Contract Pharmacy Representative
Avita Drugs
Jerry Purcell, Executive Vice President
(504) 905-4587
Signed By Date
7/11/2020
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