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AVITA DRUGS TENESSEE, LLC
HV01706 MEHARRY MEDICAL COLLEGE
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Covered Entity Details
Entity Name
MEHARRY MEDICAL COLLEGE
Subdivision Name
Type
Ryan White Part C
340B ID
HV01706
Entity Address
1005 DR. B. TODD JR BLVD
NASHVILLE, TN 37208
Grant Number
H76HA01706
Participating Start Date
7/1/2011
Last Recertification Date
3/7/2025
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
1/14/2021
Contract Begin Date
4/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
VLADIMIR BERTHAUD, EXECUTIVE DIRECTOR
(615) 327-5753
Contract Pharmacy Representative
Pharm Blue
Samantha Possert, Southeast Regional Sales Executive
(813) 734-4023
Signed By Date
1/14/2021
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