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AVITA PHARMACY 1060
CH08410A HIGH PLAINS COMMUNITY HEALTH CENTER
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Covered Entity Details
Entity Name
HIGH PLAINS COMMUNITY HEALTH CENTER
Subdivision Name
Family Health Center
Type
HRSA-Funded Health Center
340B ID
CH08410A
Entity Address
200 Kendall Dr
Lamar, CO 81052-3940
Grant Number
H80CS00214
Participating Start Date
4/1/2005
Last Recertification Date
2/25/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1060
Pharmacy Address
RX BLUE STAR SOLUTIONS, LLC DBA AVITA PH
40 PENNWOOD PL STE 200
WARRENDALE, PA 15086-6625
Pharmacy Comments
12/21/2012 address update (was 107 GEORGE RD EVANS CITY 16033); 2/23/11 UPDATED ZIP (WAS 16053)
Contract Details
Approval Date
6/26/2009
Contract Begin Date
6/26/2009
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jay Brooke, Executive Director
(719) 336-0261
Contract Pharmacy Representative
Physicians RX
Shim Sacks, COO
(412) 294-1985
Signed By Date
6/22/2009
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