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AVITA PHARMACY 1028
CHC26583-00 NO/AIDS Task Force
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Covered Entity Details
Entity Name
NO/AIDS Task Force
Subdivision Name
CrescentCare - St. Roch
Type
HRSA-Funded Health Center
340B ID
CHC26583-00
Entity Address
1631 ELYSIAN FIELDS AVE
NEW ORLEANS, LA 70117-6051
Grant Number
H80CS26583
Participating Start Date
7/1/2014
Last Recertification Date
2/19/2025
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
4/14/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NOEL TWILBECK, CEO
(504) 821-2601 Ext: 228
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, FOUNDER
(504) 905-4587
Signed By Date
4/2/2014
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