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AVITA PHARMACY 1028
STD701193 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
Ruth Fertel Clinic
Type
Sexually Transmitted Diseases
340B ID
STD701193
Entity Address
711 N. Broad Street
New Orleans, LA 70119
Grant Number
NH25PS005176-02
Participating Start Date
10/1/2020
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
8/13/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
KATHLEEN M. KOZAR, Director, Sponsored projects Administration
(504) 988-5207
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
7/15/2020
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