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AVITA PHARMACY 1040
CHC28959-00 RECOVERY CONSULTANTS OF ATLANTA, INCORPORATED
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Covered Entity Details
Entity Name
RECOVERY CONSULTANTS OF ATLANTA, INCORPORATED
Subdivision Name
Recovery Consultants: Tucker
Type
HRSA-Funded Health Center
340B ID
CHC28959-00
Entity Address
1957 Lakeside Parkway
Suite 510
Tucker, GA 30084-1837
Grant Number
H80CS28959
Participating Start Date
7/1/2019
Last Recertification Date
2/18/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
4/6/2017
Contract Begin Date
7/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2019
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Maurice Reese, COO
(678) 232-6177
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
4/6/2017
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