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AVITA PHARMACY 1037
CH06287N EXCELTH, INCORPORATED
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Covered Entity Details
Entity Name
EXCELTH, INCORPORATED
Subdivision Name
EXCELth, Inc. Dental Clinic - Algiers
Type
HRSA-Funded Health Center
340B ID
CH06287N
Entity Address
1111 Newton St
New Orleans, LA 70114-2500
Grant Number
H80CS00129
Participating Start Date
7/1/2014
Last Recertification Date
2/26/2025
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
4/17/2014
Contract Begin Date
7/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MICHAEL A. ANDRY, CEO
(504) 524-1210 Ext: 4123
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, FOUNDER
(504) 905-4587
Signed By Date
4/15/2014
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