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AVITA PHARMACY 1040
STD701155 Texas Digestive Disease Consultants
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Covered Entity Details
Entity Name
Texas Digestive Disease Consultants
Subdivision Name
New Orleans
Type
Sexually Transmitted Diseases
340B ID
STD701155
Entity Address
2820 Napoleon Avenue
Suite 720
New Orleans, LA 70115
Grant Number
NH25PS005176
Participating Start Date
4/1/2024
Last Recertification Date
5/17/2024
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
3/7/2024
Contract Begin Date
4/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Gary Michael Reiss, MD
(415) 260-0370
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/14/2024
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