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AVITA DRUGS TENNESSEE 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 TENNESSEE LLC
Pharmacy Address
DBA AVITA PHARMACY 1049
225 S 11TH ST
STE 102
NASHVILLE, TN 37206
Pharmacy Comments
Contract Details
Approval Date
1/7/2021
Contract Begin Date
1/18/2021
Carve-In Effective Date
Contract Comments
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
1/7/2021
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