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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC10591-08 COMMUNITY CLINIC, INC., THE
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Covered Entity Details
Entity Name
COMMUNITY CLINIC, INC., THE
Subdivision Name
CCI - Family Services Inc.
Type
HRSA-Funded Health Center
340B ID
CHC10591-08
Entity Address
610 E Diamond Ave STE 300
Gaithersburg, MD 20877-5321
Grant Number
H80CS10591
Participating Start Date
1/1/2014
Last Recertification Date
1/29/2019
Entity Termination Date
1/1/2020
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
1/1/2020
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
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