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AVITA PHARMACY 1040
Bebashi Transition to Hope
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Covered Entity Details
Entity Name
Bebashi Transition to Hope
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
Entity Address
4101 Woodland Avenue
Philadelphia, PA 19104
Grant Number
6NU62PS924728-03-04
Participating Start Date
Last Recertification Date
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
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sebrina Tate, Director of Programs and Administration
(215) 769-3561 Ext: 2157693561
Contract Pharmacy Representative
Nota Consulting Group, LLC
Fungisai Nota, 340B Program Manager
(610) 742-7763
Signed By Date
4/15/2025
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