Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII802201A Colorado Health Network, Inc.

Covered Entity Details

Entity Name

Colorado Health Network, Inc.

Subdivision Name

Western Region

Type

Ryan White Part B

340B ID

RWII802201A

Entity Address

1001 Wellington Ave.
Grand Junction, CO 81501

Grant Number

X07HA00056

Participating Start Date

7/1/2020

Last Recertification Date

2/12/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

6/2/2020

Contract Begin Date

7/1/2020

Carve-In Effective Date

Contract Comments

Contract Termination Date
Termination Reason

10/1/2020
Agreement registered in error

Contacts

Covered Entity Signing Official

Darrell J Vigil, Chief Executive Officer
(303) 837-0166

Contract Pharmacy Representative

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

Signed By Date

4/10/2020

340B Drug Pricing Program Database