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AVITA PHARMACY 1037
CH048800 JEFFERSON COMPREHENSIVE HEALTH CENTER INC
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Covered Entity Details
Entity Name
JEFFERSON COMPREHENSIVE HEALTH CENTER INC
Subdivision Name
JEFFERSON COMPREHENSIVE HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH048800
Entity Address
405 Main Street
Fayette, MS 39069-0098
Grant Number
H80CS00582
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1037
Pharmacy Address
AVITA DRUGS LLC-NOLA D/B/A AVITA PHARMAC
2519 CANAL ST
NEW ORLEANS, LA 70119
Pharmacy Comments
Contract Details
Approval Date
4/16/2018
Contract Begin Date
7/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
12/1/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Shirley Ellis-Stampley, CEO
(601) 786-3475
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/16/2018
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