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AVITA DRUGS TENNESSEE LLC
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 Parkway
Bartlett, TN 38133
Grant Number
NH25PS005151
Participating Start Date
4/1/2025
Last Recertification Date
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
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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