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AVITA PHARMACY 1040
CH051741L SHALOM HEALTH CARE CENTER INC
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Covered Entity Details
Entity Name
SHALOM HEALTH CARE CENTER INC
Subdivision Name
Dr. Arthur Galstian - Shalom OBGYN Practice
Type
HRSA-Funded Health Center
340B ID
CH051741L
Entity Address
9240 N Meridian STE 180
Indianapolis, IN 46260
Grant Number
H80CS00880
Participating Start Date
10/1/2023
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
4/14/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Leonardo R. Ortega, Executive Director/CEO
(317) 291-7422 Ext: 1105
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/14/2025
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