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PHARMBLUE LLC DBA AVITA PHARMACY 1059
CH03378F Quality Community Health Care, Inc.
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Covered Entity Details
Entity Name
Quality Community Health Care, Inc.
Subdivision Name
COOKE FAMILY HEALTH CENTER
Type
HRSA-Funded Health Center
340B ID
CH03378F
Entity Address
1300 W Louden St
Philadelphia, PA 19141-2603
Grant Number
H80CS00687
Participating Start Date
10/1/2021
Last Recertification Date
2/28/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/6/2021
Contract Begin Date
1/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
MARCELLA LINGHAM, CEO
(215) 227-0300 Ext: 7308
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/6/2021
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