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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD065116 APNH: A Place to Nourish your Health, Inc.
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Covered Entity Details
Entity Name
APNH: A Place to Nourish your Health, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD065116
Entity Address
1302 Chapel Street
New Haven, CT 06511
Grant Number
NU62PS924686
Participating Start Date
4/26/2021
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
4/29/2021
Contract Begin Date
4/29/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Christopher Allen Cole, Executive Director
(475) 441-7017
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/29/2021
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