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AVITA PHARMACY 1028
RWI70072A Priority Health Care
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Covered Entity Details
Entity Name
Priority Health Care
Subdivision Name
Type
Ryan White Part A
340B ID
RWI70072A
Entity Address
12 Westbank Expressway
Gretna, LA 70053
Grant Number
H89HA00035
Participating Start Date
1/1/2017
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
11/1/2016
Contract Begin Date
1/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, FOUNDER
(504) 905-4587
Signed By Date
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