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AVITA PHARMACY 1060
CHC10591-13 Community Clinic, Inc., The
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Covered Entity Details
Entity Name
Community Clinic, Inc., The
Subdivision Name
CCI-Wheaton
Type
HRSA-Funded Health Center
340B ID
CHC10591-13
Entity Address
2730 University Blvd W Ste ll10
Wheaton, MD 20902-1905
Grant Number
H80CS10591
Participating Start Date
7/1/2021
Last Recertification Date
2/10/2025
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
7/14/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Sonya J. Bruton, CEO and President
(240) 839-5107
Contract Pharmacy Representative
PharmBlue
Joseph Pohl, CEO
(724) 779-4720 Ext: 001
Signed By Date
7/14/2021
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