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AVITA PHARMACY 1040
CH031060A NEIGHBORHOOD HEALTH
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Covered Entity Details
Entity Name
NEIGHBORHOOD HEALTH
Subdivision Name
2 EAST GLEBE RD
Type
HRSA-Funded Health Center
340B ID
CH031060A
Entity Address
2 E GLEBE RD
Alexandria, VA 22305
Grant Number
H80CS02446
Participating Start Date
1/1/2007
Last Recertification Date
2/16/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
7/16/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Basim Khan, Executive Director
(703) 535-5568 Ext: 4104
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/16/2021
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