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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD22044 NovaSalud, Inc.
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Covered Entity Details
Entity Name
NovaSalud, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD22044
Entity Address
2946 Sleepy Hollow Rd
Suite 3C
FALLS CHURCH, VA 22044
Grant Number
1NH25PS005137
Participating Start Date
7/2/2021
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
7/12/2021
Contract Begin Date
7/16/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Hugo Delgado, Executive Director
(703) 589-8427
Contract Pharmacy Representative
Avita Specialty Pharmacy
Karla Sisinni, Regional 340B Consultant
(814) 323-4229
Signed By Date
7/12/2021
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