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AVITA PHARMACY 1046
CH046900 MEDCURA HEALTH, INC.
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Covered Entity Details
Entity Name
MEDCURA HEALTH, INC.
Subdivision Name
STONE MOUNTAIN
Type
HRSA-Funded Health Center
340B ID
CH046900
Entity Address
5582 MEMORIAL DRIVE
STONE MOUNTAIN, GA 30083
Grant Number
H80CS00179
Participating Start Date
4/1/2004
Last Recertification Date
2/16/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1046
Pharmacy Address
LONG'S DRUGS OF SANDERSVILLE, GEORGIA, I
2140 PEACHTREE RD NW STE 232
ATLANTA, GA 30309
Pharmacy Comments
Contract Details
Approval Date
1/9/2023
Contract Begin Date
1/9/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeff Taylor, Chief Executive Officer
(404) 298-3250
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/9/2023
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