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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD532122 Health Connections Inc.
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Covered Entity Details
Entity Name
Health Connections Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD532122
Entity Address
4655 N. Port Washington Road
Suite 300
Glendale, WI 53212-1004
Grant Number
NH25PS005148
Participating Start Date
8/4/2021
Last Recertification Date
6/3/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
7/14/2018
Contract Begin Date
10/1/2018
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2021
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Ericka Sinclair, Executive Director
(404) 218-3686
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
7/14/2018
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