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AVITA PHARMACY 1039
CHC28964-04 START CORP
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Covered Entity Details
Entity Name
START CORP
Subdivision Name
Start Community Health Center - Galvez
Type
HRSA-Funded Health Center
340B ID
CHC28964-04
Entity Address
2300 S Galvez St
New Orleans, LA 70125-3102
Grant Number
H80CS28964
Participating Start Date
10/1/2022
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1039
Pharmacy Address
1631 ELYSIAN FIELDS AVE STE 200
NEW ORLEANS, LA 70117-8208
Pharmacy Comments
Contract Details
Approval Date
7/6/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Catherine Broussard, QA/Compliance Officer
(985) 333-2020 Ext: 2005
Contract Pharmacy Representative
Avita Pharmacy Solution
mark Roth, Senior Account Executive
(504) 908-5932
Signed By Date
7/6/2022
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