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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD352222 AIDS Alabama
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Covered Entity Details
Entity Name
AIDS Alabama
Subdivision Name
Living Well Clinic
Type
Sexually Transmitted Diseases
340B ID
STD352222
Entity Address
3522 7th Avenue South
Birmingham, AL 35222
Grant Number
5NH25PS005129-03-00
Participating Start Date
1/1/2021
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
11/16/2020
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
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