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PHARMBLUE LLC DBA AVITA PHARMACY 1059
HV06021B VALLEY AIDS COUNCIL
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Covered Entity Details
Entity Name
VALLEY AIDS COUNCIL
Subdivision Name
Type
Ryan White Part C
340B ID
HV06021B
Entity Address
300 S. 2nd St
SUITE C
MCALLEN, TX 78501
Grant Number
H76HA00131
Participating Start Date
7/1/2009
Last Recertification Date
2/21/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/15/2019
Agreement registered in error
Contacts
Covered Entity Signing Official
Wally Cantu, Executive Director
(956) 428-2653
Contract Pharmacy Representative
PharmBlue, LLC
Joseph P. Pohl III, CEO
(724) 779-4720 Ext: 033
Signed By Date
10/14/2019
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