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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD02744 Health Imperatives
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Covered Entity Details
Entity Name
Health Imperatives
Subdivision Name
New Bedford Family Planning
Type
Sexually Transmitted Diseases
340B ID
STD02744
Entity Address
651 Orchard St
New Bedford, MA 02744
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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