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AVITA PHARMACY 1038
STD38133 Music City PrEP Clinic
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Covered Entity Details
Entity Name
Music City PrEP Clinic
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD38133
Entity Address
3002 N Germantown Rd
Bartlett, TN 38133
Grant Number
NH25PS005151
Participating Start Date
4/1/2025
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1038
Pharmacy Address
AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM
3308 TULANE AVE STE 102
NEW ORLEANS, LA 70119-7170
Pharmacy Comments
Contract Details
Approval Date
1/29/2025
Contract Begin Date
4/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Clark MacKinnon, Executive Director
(615) 469-1065
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/14/2025
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