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AVITA PHARMACY 1028
CHC26580-00 COMMON GROUND HEALTH CLINIC
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Covered Entity Details
Entity Name
COMMON GROUND HEALTH CLINIC
Subdivision Name
Common Ground Health Clinic
Type
HRSA-Funded Health Center
340B ID
CHC26580-00
Entity Address
3737 General DeGaulle Dr
New Orleans, LA 70114
Grant Number
H80CS26580
Participating Start Date
7/1/2014
Last Recertification Date
3/7/2025
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
4/6/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Preston Wright Jr., CEO
(504) 302-2285
Contract Pharmacy Representative
Avita Drugs
Mark Roth, Account Manager
(504) 908-5932
Signed By Date
4/6/2015
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