340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1040
CHC26587-05 SAINT HOPE FOUNDATION
Print
Covered Entity Details
Entity Name
SAINT HOPE FOUNDATION
Subdivision Name
St. Hope Community Health Clinic- Jersey Village
Type
HRSA-Funded Health Center
340B ID
CHC26587-05
Entity Address
20320 Northwest Fwy Ste 500
Jersey Village, TX 77065
Grant Number
H80CS26587
Participating Start Date
4/1/2022
Last Recertification Date
2/18/2025
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
5/12/2022
Contract Begin Date
5/17/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Timika Sam-Cooper, Chief Operations Officer
(713) 778-1300 Ext: 2342
Contract Pharmacy Representative
Avita
Shelley Gautreau, 340B Program Controller
(225) 772-1906
Signed By Date
5/12/2022
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