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AVITA PHARMACY 1060
CH060740 United Medical Centers
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Covered Entity Details
Entity Name
United Medical Centers
Subdivision Name
United Medical Centers Inc.
Type
HRSA-Funded Health Center
340B ID
CH060740
Entity Address
2525 N Veterans Blvd
Eagle Pass, TX 78852-3302
Grant Number
H80CS00643
Participating Start Date
12/1/1992
Last Recertification Date
2/11/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1060
Pharmacy Address
RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH
40 PENNWOOD PL STE 200
WARRENDALE, PA 15086-6625
Pharmacy Comments
12/21/2012 address update (was 107 GEORGE RD EVANS CITY 16033); 2/23/11 UPDATED ZIP (WAS 16053)
Contract Details
Approval Date
10/14/2019
Contract Begin Date
1/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
William Worrell, CEO/Administrator
(830) 773-8917
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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