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AVITA PHARMACY 1040
RWI20020 Family and Medical Counseling Service, Inc.
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Covered Entity Details
Entity Name
Family and Medical Counseling Service, Inc.
Subdivision Name
Type
Ryan White Part A
340B ID
RWI20020
Entity Address
2041 Martin Luther King, Jr. Avenue, SE
Suite 303
Washington, DC 20020
Grant Number
H89HA00012
Participating Start Date
1/1/2013
Last Recertification Date
2/18/2025
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
10/15/2024
Contract Begin Date
1/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Flora Terrell Hamilton, CEO
(202) 889-7900 Ext: 217
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/15/2024
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