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AVITA PHARMACY 1028
CHC26582-00 MQVN COMMUNITY DEVELOPMENT CORP
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Covered Entity Details
Entity Name
MQVN COMMUNITY DEVELOPMENT CORP
Subdivision Name
NOELA Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC26582-00
Entity Address
13085 Chef Menteur Hwy
New Orleans, LA 70129-2130
Grant Number
H80CS26582
Participating Start Date
10/1/2014
Last Recertification Date
2/12/2025
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
4/14/2015
Contract Begin Date
7/1/2015
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Diem Nguyen, CEO
(504) 255-9170
Contract Pharmacy Representative
Avita Drugs
Mark Roth, Account Manager
(504) 908-5932
Signed By Date
4/14/2015
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