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AVITA PHARMACY 1040
CH0423590 Tandem Health SC
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Covered Entity Details
Entity Name
Tandem Health SC
Subdivision Name
Tandem Health
Type
HRSA-Funded Health Center
340B ID
CH0423590
Entity Address
1278 North Lafayette Drive
Sumter, SC 29150-2964
Grant Number
H80CS00868
Participating Start Date
1/1/2004
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Annie Brown, CEO
(803) 774-4500 Ext: 545
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/16/2023
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