Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII77802 Unity Partners

Covered Entity Details

Entity Name

Unity Partners

Subdivision Name

Project Unity

Type

Ryan White Part B

340B ID

RWII77802

Entity Address

3833 S Texas Ave.
Ste. 150
Bryan, TX 77802

Grant Number

X07HA00054

Participating Start Date

7/1/2019

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

6/7/2019

Contract Begin Date

7/1/2019

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Ella McGruder, Programs Director
(979) 595-2900

Contract Pharmacy Representative

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

Signed By Date

5/3/2019

340B Drug Pricing Program Database