Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
HV171102 R.E.A.C.C.H. PROGRAM

Covered Entity Details

Entity Name

R.E.A.C.C.H. PROGRAM

Subdivision Name

PINNACLE HEALTH MEDICAL SERVICES

Type

Ryan White Part C

340B ID

HV171102

Entity Address

2501 NORTH THIRD ST
HARRISBURG, PA 17110

Grant Number

H76HA00617-25-00

Participating Start Date

10/1/2001

Last Recertification Date

2/20/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

10/3/2013

Contract Begin Date

1/1/2014

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

1/10/2017
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Laura Brubaker, PROGRAM COORDINATOR
(717) 782-2363

Contract Pharmacy Representative

PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001

Signed By Date

10/3/2013

340B Drug Pricing Program Database