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AVITA PHARMACY 1037
RWII70119 NO/AIDS Task Force (d.b.a. CrescentCare)
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Covered Entity Details
Entity Name
NO/AIDS Task Force (d.b.a. CrescentCare)
Subdivision Name
CrescentCare - St. Roch
Type
Ryan White Part B
340B ID
RWII70119
Entity Address
1631 ELYSIAN FIELDS AVE
NEW ORLEANS, LA 70117
Grant Number
X07HA00018
Participating Start Date
1/1/2013
Last Recertification Date
3/7/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1037
Pharmacy Address
AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC
2519 CANAL ST
NEW ORLEANS, LA 70119
Pharmacy Comments
Contract Details
Approval Date
3/14/2013
Contract Begin Date
4/1/2013
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NOEL TWILBECK, CEO
(504) 821-2601 Ext: 228
Contract Pharmacy Representative
Avita Drugs
KEITH FOX, CFO
(225) 236-1540
Signed By Date
1/15/2013
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