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AVITA PHARMACY 1058
STD28083 CABARRUS HEALTH ALLIANCE
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Covered Entity Details
Entity Name
CABARRUS HEALTH ALLIANCE
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD28083
Entity Address
300 Mooresville Road
KANNAPOLIS, NC 28081
Grant Number
6NH25PS005152-05-07
Participating Start Date
1/1/2009
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1058
Pharmacy Address
MEDEXPRESS PHARMACY, LTD. DBA AVITA PHAR
1431 W. INNES ST.
SALISBURY, NC 28144
Pharmacy Comments
Contract Details
Approval Date
12/14/2020
Contract Begin Date
12/15/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sue K. Yates, Chief Financial Officer
(704) 920-1212
Contract Pharmacy Representative
Avita/Longs
Veleria Levy, Account Rep.
(704) 293-3504
Signed By Date
12/14/2020
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