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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH030700 CENTRAL VIRGINIA HEALTH SERVICES, INC.
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Covered Entity Details
Entity Name
CENTRAL VIRGINIA HEALTH SERVICES, INC.
Subdivision Name
CVHS Buckingham
Type
HRSA-Funded Health Center
340B ID
CH030700
Entity Address
25892 N James Madison Hwy
New Canton, VA 23123-2234
Grant Number
H80CS00479
Participating Start Date
7/1/1995
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/12/2021
Contract Begin Date
7/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Paula Anne Tomko, Chief Executive Officer
(434) 581-3276
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/12/2021
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