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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD02554 Health Imperatives
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Covered Entity Details
Entity Name
Health Imperatives
Subdivision Name
Nantucket Family Planning
Type
Sexually Transmitted Diseases
340B ID
STD02554
Entity Address
20 Vesper Lane
#3
Nantucket, MA 02554
Grant Number
6NH25PS004332-03-01
Participating Start Date
4/1/2017
Last Recertification Date
5/16/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/15/2018
Contract Begin Date
1/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Emily Gold, Director of Reproductive Health Services
(508) 274-6541
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
10/15/2018
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