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AVITA PHARMACY 1041
RWII70501 ACADIANA CARES
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Covered Entity Details
Entity Name
ACADIANA CARES
Subdivision Name
Type
Ryan White Part B
340B ID
RWII70501
Entity Address
809 MARTIN LUTHER KING JR. DRIVE
LAFAYETTE, LA 70501
Grant Number
X07HA00018
Participating Start Date
1/1/2015
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1041
Pharmacy Address
AVITA DRUGS LLC D/B/A AVITA PHARMACY 104
1715 COMMON ST STE A
LAKE CHARLES, LA 70601-6135
Pharmacy Comments
Contract Details
Approval Date
4/17/2025
Contract Begin Date
7/1/2025
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Claude Martin, CEO
(337) 233-2437 Ext: 125
Contract Pharmacy Representative
Avita Drugs LLC
Nick Kersey, Strategic Account Exec
(754) 213-6176
Signed By Date
4/17/2025
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