Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII352223B AIDS Alabama

Covered Entity Details

Entity Name

AIDS Alabama

Subdivision Name

Living Well Clinic

Type

Ryan White Part B

340B ID

RWII352223B

Entity Address

3522 7th Avenue South
Birmingham, AL 35222

Grant Number

X07HA00049

Participating Start Date

1/1/2021

Last Recertification Date

2/14/2025

Pharmacy Details

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Contract Details

Approval Date

11/30/2020

Contract Begin Date

1/1/2021

Carve-In Effective Date

Contract Comments

Contacts

Covered Entity Signing Official

Katherine Elizabeth McMullen, Director of Programs Administration
(205) 918-8196

Contract Pharmacy Representative

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

Signed By Date

10/13/2020

340B Drug Pricing Program Database