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AVITA PHARMACY 1046
CHC24129-00 ATHENS NEIGHBORHOOD HEALTH CENTER
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Covered Entity Details
Entity Name
ATHENS NEIGHBORHOOD HEALTH CENTER
Subdivision Name
Athens Neighborhood Health Center, Inc.
Type
HRSA-Funded Health Center
340B ID
CHC24129-00
Entity Address
675 College Ave
Athens, GA 30601-2635
Grant Number
H80CS24129
Participating Start Date
1/1/2014
Last Recertification Date
2/11/2025
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
5/9/2023
Contract Begin Date
5/9/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Marcus Garner, CEO
(404) 788-5870
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
5/9/2023
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