Contract Pharmacy Details

AVITA PHARMACY 1028
RWI70072 PRIORITY HEALTH CARE

Covered Entity Details

Entity Name

PRIORITY HEALTH CARE

Subdivision Name

Type

Ryan White Part A

340B ID

RWI70072

Entity Address

4700 Wichers Drive
304-305
Marrero, LA 70072

Grant Number

H89HA00035

Participating Start Date

7/1/2011

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1028

Pharmacy Address

340B PARTNERS PHARMACY-DALLAS LLC DBA AV
750 FORT WORTH AVE STE H100
DALLAS, TX 75208-1811

Pharmacy Comments

Contract Details

Approval Date

4/22/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

FRAN LAWLESS, DIRECTOR MAYOR'S OFFICE OF HEALTH POLICY & AIDS
(504) 658-2804

Contract Pharmacy Representative

Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587

Signed By Date

4/22/2016

340B Drug Pricing Program Database