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LONG'S DEKALB HEALTH PHARMACY
FP30303 Empowerment Resource Center
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Covered Entity Details
Entity Name
Empowerment Resource Center
Subdivision Name
Comprehensive Intervention Clinic
Type
Family Planning (Title X only)
340B ID
FP30303
Entity Address
230 Peachtree St NW
SUITE 1800
ATLANTA, GA 30303-1514
Grant Number
FPHPA046164
Participating Start Date
4/1/2016
Last Recertification Date
5/8/2024
Pharmacy Details
Pharmacy Name
LONG'S DEKALB HEALTH PHARMACY
Pharmacy Address
AVITA PHARMACY 1045
1428 SCOTT BLVD
DECATUR, GA 30030
Pharmacy Comments
Contract Details
Approval Date
4/12/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/9/2023
Pharmacy closed
Contacts
Covered Entity Signing Official
Jacqueline Brown, Chief Executive Officer
(404) 526-1145
Contract Pharmacy Representative
Avita Drugs
JERRY PURCELL, EVP
(504) 905-4587
Signed By Date
4/12/2018
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