340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
AVITA PHARMACY 1046
RWI30311A Heather Ivy Society
Print
Covered Entity Details
Entity Name
Heather Ivy Society
Subdivision Name
Heather Ivy Society
Type
Ryan White Part A
340B ID
RWI30311A
Entity Address
381 Forest Parkway
Suite B
Forest Park, GA 30297
Grant Number
UT8HA33933
Participating Start Date
4/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1046
Pharmacy Address
LONG'S DRUGS OF SANDERSVILLE, GEORGIA, I
2140 PEACHTREE RD NW STE 232
ATLANTA, GA 30309
Pharmacy Comments
Contract Details
Approval Date
2/11/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Zandraetta Tims-Cook, Executive Director
(844) 884-9691 Ext: 1
Contract Pharmacy Representative
Avita
Shawn Smith, Sr Account Executive
(305) 906-2937
Signed By Date
1/7/2025
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session