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AVITA PHARMACY 1040
CH09072D NORTH COUNTY HEALTH PROJECT, INC
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Covered Entity Details
Entity Name
NORTH COUNTY HEALTH PROJECT, INC
Subdivision Name
TrueCare
Type
HRSA-Funded Health Center
340B ID
CH09072D
Entity Address
1130 2nd St
Encinitas, CA 92024-5008
Grant Number
H80CS00228
Participating Start Date
1/1/1997
Last Recertification Date
2/11/2025
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
11/22/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marie Russell, Chief Medical Officer
(760) 736-8689
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
11/22/2022
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