340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1058
STD27403 Triad Health Project
Print
Covered Entity Details
Entity Name
Triad Health Project
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD27403
Entity Address
801 Summit Avenue
Greensboro, NC 27405
Grant Number
6 NH25PS005152-02-01
Participating Start Date
4/1/2021
Last Recertification Date
5/14/2024
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
4/13/2021
Contract Begin Date
4/19/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mark Cassity, Executive Director
(336) 275-1654
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/13/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session