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AVITA PHARMACY 1040
RWII45223 Caracole, Inc.
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Covered Entity Details
Entity Name
Caracole, Inc.
Subdivision Name
Type
Ryan White Part B
340B ID
RWII45223
Entity Address
4138 Hamilton Avenue
Cincinnati, OH 45223
Grant Number
X07HA00016
Participating Start Date
4/1/2014
Last Recertification Date
2/28/2025
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
10/12/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Linda Seiter, Executive Director
(513) 619-1486
Contract Pharmacy Representative
Avita Pharmacy
Chris Casseri, SVP Sales Acct Mgmt and Marketing
(225) 773-7218
Signed By Date
10/12/2022
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