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AVITA PHARMACY 1038
CHC26583-02 NO/AIDS TASK FORCE
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Covered Entity Details
Entity Name
NO/AIDS TASK FORCE
Subdivision Name
CrescentCare Mid-City
Type
HRSA-Funded Health Center
340B ID
CHC26583-02
Entity Address
2515 Canal St
NEW ORLEANS, LA 70119
Grant Number
H80CS26583
Participating Start Date
1/1/2015
Last Recertification Date
2/19/2025
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
1/14/2018
Contract Begin Date
4/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
NOEL John TWILBECK, CEO
(504) 821-2601 Ext: 1000
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, FOUNDER
(504) 905-4587
Signed By Date
1/14/2018
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