Contract Pharmacy Details

PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC10591-13 Community Clinic, Inc., The

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

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

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

340B Drug Pricing Program Database