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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD01702 Justice Resource Institute
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Covered Entity Details
Entity Name
Justice Resource Institute
Subdivision Name
JRI Health
Type
Sexually Transmitted Diseases
340B ID
STD01702
Entity Address
1 Grant St.
Program RISE
100
Framingham, MA 01702
Grant Number
5 NH25PS004332-05-00
Participating Start Date
1/1/2020
Last Recertification Date
5/8/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
12/4/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John Gatto, Senior VP for Community Health
(781) 599-4900 Ext: 3380
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
10/3/2019
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