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AVITA PHARMACY 1043
HV01706A MEHARRY COMMUNITY WELLNESS CENTER
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Covered Entity Details
Entity Name
MEHARRY COMMUNITY WELLNESS CENTER
Subdivision Name
METROPOLITAN INTERDENOMINOTIONAL CHURCH/FIRST RESPONSE CENTER
Type
Ryan White Part C
340B ID
HV01706A
Entity Address
2128 11th avenue North
NASHVILLE, TN 37208
Grant Number
H76HA01706
Participating Start Date
9/10/2021
Last Recertification Date
2/26/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1043
Pharmacy Address
AVITA DRUGS MISSISSIPPI LLC D/B/A AVITA
805 E RIVER PL STE A
JACKSON, MS 39202-3486
Pharmacy Comments
Contract Details
Approval Date
9/10/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
9/10/2021
Agreement registered in error
Contacts
Covered Entity Signing Official
VLADIMIR BERTHAUD, EXECUTIVE DIRECTOR
(615) 327-5753
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
9/10/2021
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