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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH0510700 OPEN DOOR HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
OPEN DOOR HEALTH SERVICES, INC.
Subdivision Name
Open Door Health Services
Type
HRSA-Funded Health Center
340B ID
CH0510700
Entity Address
333 S Madison Street
Suite 79
Muncie, IN 47305
Grant Number
H80CS00340
Participating Start Date
4/1/2001
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/15/2019
Contract Begin Date
7/1/2019
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Bryan Ayars, CEO
(765) 747-2971
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
4/15/2019
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