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PHARMBLUE LLC DBA AVITA PHARMACY 1059
HV28358 ROBESON HEALTH CARE CORPORATION
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Covered Entity Details
Entity Name
ROBESON HEALTH CARE CORPORATION
Subdivision Name
LUMBERTON HEALTH CENTER
Type
Ryan White Part C
340B ID
HV28358
Entity Address
1309 East 5th Street
LUMBERTON, NC 28358
Grant Number
H76HA00816
Participating Start Date
7/1/2016
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
Contract Termination Date
Termination Reason
4/1/2016
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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