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AVITA PHARMACY 1038
HV00206 Beaufort Jasper Hampton Comprehensive Health Services, Inc.
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Covered Entity Details
Entity Name
Beaufort Jasper Hampton Comprehensive Health Services, Inc.
Subdivision Name
Type
Ryan White Part C
340B ID
HV00206
Entity Address
721 N Okatie Highway 170
Ridgeland, SC 29936-8276
Grant Number
H76HA00206
Participating Start Date
10/1/2017
Last Recertification Date
2/13/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1038
Pharmacy Address
AVITA DRUGS LLC-NOLA 2 D/B/A AVITA PHARM
3308 TULANE AVE STE 102
NEW ORLEANS, LA 70119-7170
Pharmacy Comments
Contract Details
Approval Date
7/21/2017
Contract Begin Date
10/1/2017
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
11/30/2023
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Contract Pharmacy Representative
PMQ Group, LLC dba Avita
Chris Creamer, SVP
(469) 592-2000
Signed By Date
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