Contract Pharmacy Details

AVITA PHARMACY 1060
CHC10591-08 COMMUNITY CLINIC, INC., THE

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

AVITA PHARMACY 1060

Pharmacy Address

RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH
40 PENNWOOD PL STE 200
WARRENDALE, PA 15086-6625

Pharmacy Comments

12/21/2012 address update (was 107 GEORGE RD EVANS CITY 16033); 2/23/11 UPDATED ZIP (WAS 16053)

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

340B Drug Pricing Program Database