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AVITA PHARMACY 1040
CH040760 G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.
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Covered Entity Details
Entity Name
G.A. CARMICHAEL FAMILY HEALTH CENTER, INC.
Subdivision Name
G. A. CARMICHAEL FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH040760
Entity Address
1668 W Peace St
Canton, MS 39046-5332
Grant Number
H80CS00484
Participating Start Date
10/1/2013
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1040
Pharmacy Address
AVITA DRUGS, LLC D/B/A AVITA PHARMACY 10
6100 CORPORATE BLVD STE 250
BATON ROUGE, LA 70808
Pharmacy Comments
Contract Details
Approval Date
4/13/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
James L. Coleman Jr., CEO
(601) 859-5213 Ext: 2291
Contract Pharmacy Representative
Avita Pharmacy Solution
mark Roth, Senior Account Executive
(504) 908-5932
Signed By Date
4/13/2018
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