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AVITA DRUGS TENNESSEE LLC
STD33811 Pineapple Healthcare
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Covered Entity Details
Entity Name
Pineapple Healthcare
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD33811
Entity Address
1724 33rd Street Suite 100
Orlando, FL 32839
Grant Number
NH25PS005131
Participating Start Date
9/21/2021
Last Recertification Date
5/6/2024
Pharmacy Details
Pharmacy Name
AVITA DRUGS TENNESSEE LLC
Pharmacy Address
DBA AVITA PHARMACY 1049
225 S 11TH ST
STE 102
NASHVILLE, TN 37206
Pharmacy Comments
Contract Details
Approval Date
4/12/2024
Contract Begin Date
7/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Ethan Michael Suarez, President
(407) 839-7278
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/12/2024
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