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AVITA DRUGS TENNESSEE 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 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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