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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH04900A ROBESON HEALTH CARE CORP
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Covered Entity Details
Entity Name
ROBESON HEALTH CARE CORP
Subdivision Name
South Robeson Medical Center - New Construction
Type
HRSA-Funded Health Center
340B ID
CH04900A
Entity Address
210 S Walnut St
Fairmont, NC 28340-1956
Grant Number
H80CS00107
Participating Start Date
1/1/2003
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/14/2013
Contract Begin Date
1/1/2014
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Thomas E. Manynor II, Deputy President and CEO
(910) 521-2900 Ext: 104
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
10/14/2013
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