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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD198012 AIDS Delaware, Inc
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Covered Entity Details
Entity Name
AIDS Delaware, Inc
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD198012
Entity Address
100 W. 10th Street
Suite #315
Wilmington, DE 19801
Grant Number
5NH25PS005156-05-01
Participating Start Date
11/29/2022
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
11/29/2022
Contract Begin Date
1/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
John P. Gardner, Executive Director
(302) 652-6776 Ext: 206
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/13/2022
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