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AVITA PHARMACY 1028
CHC28964-00 START CORPORATION
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Covered Entity Details
Entity Name
START CORPORATION
Subdivision Name
Start Community Health Center
Type
HRSA-Funded Health Center
340B ID
CHC28964-00
Entity Address
420 MAGNOLIA ST
HOUMA, LA 70360-6304
Grant Number
H80CS28964
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
1/19/2017
Contract Begin Date
4/1/2017
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Trudy Franks, Clinic Director
(985) 333-2020 Ext: 2001
Contract Pharmacy Representative
Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587
Signed By Date
1/19/2017
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