Contract Pharmacy Details

870 SOUTHERN DRUG CORP
RWI10302 Project Hospitality Incorporated

Covered Entity Details

Entity Name

Project Hospitality Incorporated

Subdivision Name

Type

Ryan White Part A

340B ID

RWI10302

Entity Address

100 Park Avenue
Staten island, NY 10302

Grant Number

H89HA00015

Participating Start Date

4/1/2020

Last Recertification Date

2/11/2025

Pharmacy Details

Pharmacy Name

870 SOUTHERN DRUG CORP

Pharmacy Address

D/B/A AVITA PHARMACY 1064
924 MYRTLE AVE
BROOKLYN, NY 11206

Pharmacy Comments

Contract Details

Approval Date

3/6/2020

Contract Begin Date

4/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

4/14/2023
Business decision by covered entity and/or pharmacy

Contacts

Covered Entity Signing Official

Carrie Z Bloss, Executive Director
(718) 448-1544 Ext: 107

Contract Pharmacy Representative

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

Signed By Date

1/6/2020

340B Drug Pricing Program Database