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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD468061 Positive Resource Connection
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Covered Entity Details
Entity Name
Positive Resource Connection
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD468061
Entity Address
525 Oxford Street
Fort Wayne, IN 46806
Grant Number
NU62PS9245556
Participating Start Date
10/1/2022
Last Recertification Date
5/14/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
8/2/2022
Contract Begin Date
10/1/2022
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jeffrey Markley, Executive Director
(260) 744-1144
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/20/2022
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