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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD199775 DELAWARE HOME FOR THE CHRONICALLY ILL
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Covered Entity Details
Entity Name
DELAWARE HOME FOR THE CHRONICALLY ILL
Subdivision Name
DHCI
Type
Sexually Transmitted Diseases
340B ID
STD199775
Entity Address
100 SUNNYSIDE ROAD
SMYRNA, DE 19977
Grant Number
NH25PS005156
Participating Start Date
10/1/2023
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
4/13/2021
Contract Begin Date
4/29/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2023
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Theo D Hudson, STD Program Director
(302) 744-1063
Contract Pharmacy Representative
AVITA Pharmacy
JERRY PURCEL, Executive VP
(504) 905-4587
Signed By Date
4/13/2021
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