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AVITA PHARMACY 1040
CHC33795-01 Monterey, County Of
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Covered Entity Details
Entity Name
Monterey, County Of
Subdivision Name
Monterey County Clinic at Marina
Type
HRSA-Funded Health Center
340B ID
CHC33795-01
Entity Address
3155 De Forest Rd
Marina, CA 93933-2702
Grant Number
H80CS33795
Participating Start Date
1/1/2020
Last Recertification Date
3/4/2025
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
1/9/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Prashant Shinde, Bureau Chief
(831) 796-1370
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/9/2023
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