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AVITA PHARMACY 1040
HV00793 CATAWBA VALLEY MEDICAL CENTER
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Covered Entity Details
Entity Name
CATAWBA VALLEY MEDICAL CENTER
Subdivision Name
FAIRGROVE PRIMARY HEALTH
Type
Ryan White Part C
340B ID
HV00793
Entity Address
3412 GRAYSTONE PLACE
SUITE A
CONOVER, NC 28613
Grant Number
H76HA00793
Participating Start Date
7/1/2011
Last Recertification Date
2/13/2025
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
1/15/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
DAVID BOONE, CFO
(828) 326-3808
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
1/15/2016
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