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AVITA PHARMACY 1037
CH067570 CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTH
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Covered Entity Details
Entity Name
CAPITOL CITY FAMILY HEALTH CENTER INC dba CARESOUTH
Subdivision Name
CAPITOL CITY FAMILY HEALTH CENTER, INC dba CARESOUTH
Type
HRSA-Funded Health Center
340B ID
CH067570
Entity Address
3140 FLORIDA BLVD
BATON ROUGE, LA 70806
Grant Number
H80CS00504
Participating Start Date
10/1/2004
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1037
Pharmacy Address
AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC
2519 CANAL ST
NEW ORLEANS, LA 70119
Pharmacy Comments
Contract Details
Approval Date
2/9/2012
Contract Begin Date
2/9/2012
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
RHONDA R. LITT, CHIEF EXECUTIVE OFFICER
(225) 650-2026
Contract Pharmacy Representative
Avita Drugs
KEITH FOX, CFO
(225) 236-1540
Signed By Date
1/24/2012
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