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AVITA PHARMACY 1039
STD704032 David L. Schneider, M.D., A.P.M.C.
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Covered Entity Details
Entity Name
David L. Schneider, M.D., A.P.M.C.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD704032
Entity Address
15825 Professional Plaza, Suite A
Hammond, LA 70403
Grant Number
NH25PS005176
Participating Start Date
9/22/2022
Last Recertification Date
5/7/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1039
Pharmacy Address
1631 ELYSIAN FIELDS AVE STE 200
NEW ORLEANS, LA 70117-8208
Pharmacy Comments
Contract Details
Approval Date
10/13/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Adil Aryman Fatakia, MD
(504) 895-5357 Ext: 1
Contract Pharmacy Representative
Avita
Keith Fox, Senior VP National Accounts
(225) 315-8186
Signed By Date
10/13/2023
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