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AVITA PHARMACY 1044
STD372062 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
STD372062
Entity Address
3309 Cummings Hwy
104
Chattanooga, TN 37419
Grant Number
NH25PS005151
Participating Start Date
7/1/2025
Last Recertification Date
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1044
Pharmacy Address
AVITA DRUGS ALABAMA LLC D/B/A AVITA PHAR
3220 5TH AVE S STE 110
BIRMINGHAM, AL 35222-2309
Pharmacy Comments
Contract Details
Approval Date
4/29/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Clark MacKinnon, Executive Director
(615) 469-1065
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
4/12/2025
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