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AVITA PHARMACY 1058
STD283011 Community Health Interventions and Sickle Cell Agency, Inc
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Covered Entity Details
Entity Name
Community Health Interventions and Sickle Cell Agency, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD283011
Entity Address
2409 Murchison Road
Fayetteville, NC 28301
Grant Number
6 NH25PS005152-05-07
Participating Start Date
10/1/2019
Last Recertification Date
5/22/2024
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
6/8/2021
Contract Begin Date
6/8/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Delvin McAllister, CEO
(910) 488-6118
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
6/8/2021
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