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AVITA PHARMACY 1028
RWI70806 HIV/AIDS ALLIANCE FOR REGION TWO, INC.
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Covered Entity Details
Entity Name
HIV/AIDS ALLIANCE FOR REGION TWO, INC.
Subdivision Name
BATON ROUGE
Type
Ryan White Part A
340B ID
RWI70806
Entity Address
3849 North Blvd
BATON ROUGE, LA 70806
Grant Number
H89HA11432
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1028
Pharmacy Address
340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811
Pharmacy Comments
Contract Details
Approval Date
1/23/2014
Contract Begin Date
4/1/2014
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sylvia Andrews, Assistant Director
(225) 358-4512
Contract Pharmacy Representative
Avita Drugs
KEITH FOX, CFO
(225) 236-1540
Signed By Date
1/23/2014
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