340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD954042 Face to Face/Sonoma County AIDS Network
Print
Covered Entity Details
Entity Name
Face to Face/Sonoma County AIDS Network
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD954042
Entity Address
873 2nd Street
Santa Rosa, CA 95404
Grant Number
6NU62PS924557-01-02
Participating Start Date
3/12/2021
Last Recertification Date
5/9/2023
Entity Termination Date
4/1/2024
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
3/12/2021
Contract Begin Date
3/12/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Sara Brewer, Executive Director
(707) 544-1581
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
3/12/2021
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session