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AVITA PHARMACY 1038
STD701191 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 Mid-City
Type
Sexually Transmitted Diseases
340B ID
STD701191
Entity Address
2515 Canal Street
New Orleans, LA 70117
Grant Number
NH25PS005176
Participating Start Date
10/1/2013
Last Recertification Date
5/7/2025
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
3/29/2016
Contract Begin Date
4/1/2016
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Noel Twilbeck, CEO
(504) 821-2601 Ext: 228
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
3/29/2016
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