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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CHC29004-00 HOWARD BROWN HEALTH CENTER
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Covered Entity Details
Entity Name
HOWARD BROWN HEALTH CENTER
Subdivision Name
Howard Brown Health Center-Clark
Type
HRSA-Funded Health Center
340B ID
CHC29004-00
Entity Address
6500 N Clark St
Chicago, IL 60626-4002
Grant Number
H80CS29004
Participating Start Date
4/1/2016
Last Recertification Date
2/12/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
7/15/2021
Contract Begin Date
10/1/2021
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
10/3/2022
Business decision by covered entity and/or pharmacy
Contacts
Covered Entity Signing Official
Anthony Scott Armstrong, Vice President of Strategy and Business Development
(407) 765-5579
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/15/2021
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