Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC10591-05 COMMUNITY CLINIC, INC., THE

Covered Entity Details

Entity Name

COMMUNITY CLINIC, INC., THE

Subdivision Name

CCI-Greenbelt

Type

HRSA-Funded Health Center

340B ID

CHC10591-05

Entity Address

7615 Ora Glen Drive
Greenbelt, MD 20770-1004

Grant Number

H80CS10591

Participating Start Date

1/1/2014

Last Recertification Date

2/1/2024

Entity Termination Date

4/1/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

1/3/2019

Contract Begin Date

4/1/2019

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/1/2025
Covered Entity Terminated

Contacts

Covered Entity Signing Official

Kathleen Knolhoff, CEO & President
(240) 499-2609

Contract Pharmacy Representative

PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033

Signed By Date

1/3/2019

340B Drug Pricing Program Database