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AVITA PHARMACY 1029
STD70130 St. Thomas Community Health Center
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Covered Entity Details
Entity Name
St. Thomas Community Health Center
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD70130
Entity Address
1020 St. Andrew Street
New Orleans, LA 70130
Grant Number
STD-LA
Participating Start Date
10/1/2013
Last Recertification Date
4/26/2018
Entity Termination Date
7/1/2019
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1029
Pharmacy Address
340B PARTNERS PHARMACY LLC D/B/A AVITA P
303 N FRIO ST
SUITE 102
SAN ANTONIO, TX 78207-3034
Pharmacy Comments
Contract Details
Approval Date
4/11/2016
Contract Begin Date
7/1/2016
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Donald Erwin, CEO
(504) 529-5558
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
4/11/2016
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