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AVITA PHARMACY 1040
CH09354P NEIGHBORHOOD HEALTHCARE
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Covered Entity Details
Entity Name
NEIGHBORHOOD HEALTHCARE
Subdivision Name
Neighborhood Healthcare ~ Prenatal
Type
HRSA-Funded Health Center
340B ID
CH09354P
Entity Address
488 E Valley Pkwy
Suite #404
Escondido, CA 92025-3363
Grant Number
H80CS00285
Participating Start Date
7/1/2018
Last Recertification Date
3/6/2025
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
LISA DAIGLE, CFO
(760) 737-6901
Contract Pharmacy Representative
Avita
Keith Fox, Senior VP National Accounts
(225) 315-8186
Signed By Date
4/14/2025
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