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AVITA PHARMACY 1028
CH0618980 Rkm Primary Care
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Covered Entity Details
Entity Name
Rkm Primary Care
Subdivision Name
RKM Primary Care
Type
HRSA-Funded Health Center
340B ID
CH0618980
Entity Address
11990 JACKSON STREET
CLINTON, LA 70722
Grant Number
H80CS06459
Participating Start Date
9/9/2005
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
7/25/2016
Contract Begin Date
10/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
5/14/2024
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
GINGER A. HUNT, EXECUTIVE DIRECTOR
(225) 683-5292
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
7/25/2016
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