Contract Pharmacy Details

AVITA PHARMACY 1038
STD700433 David L. Schneider, M.D., A.P.M.C.

Covered Entity Details

Entity Name

David L. Schneider, M.D., A.P.M.C.

Subdivision Name

David L. Schneider, M.D., A.P.M.C.

Type

Sexually Transmitted Diseases

340B ID

STD700433

Entity Address

2611 Jackson Blvd
Chalmette, LA 70043

Grant Number

NH25PS005176

Participating Start Date

1/1/2024

Last Recertification Date

5/7/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1038

Pharmacy Address

AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM
3308 TULANE AVE STE 102
NEW ORLEANS, LA 70119-7170

Pharmacy Comments

Contract Details

Approval Date

12/6/2023

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

340B Drug Pricing Program Database