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AVITA DRUGS TENESSEE, LLC
STD37204 Nashville CARES
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Covered Entity Details
Entity Name
Nashville CARES
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD37204
Entity Address
442 Metroplex Dr.
Building D Suite 100
Nashville, TN 37211
Grant Number
NU62PS924701
Participating Start Date
7/22/2020
Last Recertification Date
5/16/2024
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
7/22/2020
Contract Begin Date
7/23/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/6/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Amna Osman, CEO
(615) 762-6953
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/13/2020
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