Contract Pharmacy Details

AVITA PHARMACY 1038
RWIID70112 STD/HIV Program

Covered Entity Details

Entity Name

STD/HIV Program

Subdivision Name

OFFICE OF PUBLIC HEALTH

Type

Ryan White Part B ADAP Direct Purchase

340B ID

RWIID70112

Entity Address

1450 POYDRAS ST.
Suite 2136
NEW ORLEANS, LA 70112

Grant Number

X07HA00018

Participating Start Date

7/1/1998

Last Recertification Date

2/14/2025

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

6/30/2016

Contract Begin Date

7/1/2016

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

DeAnn Gruber, Administrative Director Louisiana OPH STD/HIV Program
(504) 568-7474

Contract Pharmacy Representative

Avita Pharmacy
JERRY PURCELL, CEO/PRESIDENT
(504) 905-4587

Signed By Date

6/30/2016

340B Drug Pricing Program Database