Contract Pharmacy Details

AVITA PHARMACY 1039
STD700724 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. d/b/a ENT of New Orleans

Type

Sexually Transmitted Diseases

340B ID

STD700724

Entity Address

1151 Barataria Blvd
3100
Marrero, LA 70072

Grant Number

NH25PS005176

Participating Start Date

1/1/2024

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

12/7/2023

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