Contract Pharmacy Details

AVITA PHARMACY 1038
RWI70112 THE ADMINISTRATORS OF THE TULANE EDUCATIONAL FUND

Covered Entity Details

Entity Name

THE ADMINISTRATORS OF THE TULANE EDUCATIONAL FUND

Subdivision Name

TULANE TOTAL HEALTH CLINIC

Type

Ryan White Part A

340B ID

RWI70112

Entity Address

711 North Broad Street
New Orleans, LA 70119

Grant Number

H89HA00035

Participating Start Date

7/1/2018

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

AVITA PHARMACY 1038

Pharmacy Address

AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM
3308 TULANE AVE STE 102
NEW ORLEANS, LA 70119-7170

Pharmacy Comments

Contract Details

Approval Date

6/28/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2018
Covered Entity Terminated

Contacts

Covered Entity Signing Official

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

Contract Pharmacy Representative

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

Signed By Date

6/28/2016

340B Drug Pricing Program Database