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AVITA DRUGS TENESSEE, LLC
STD37206 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
STD37206
Entity Address
501 28th Ave. N
Nashville, TN 37209
Grant Number
NH25PS005151
Participating Start Date
7/1/2018
Last Recertification Date
5/15/2024
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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