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PHARMBLUE LLC DBA AVITA PHARMACY 1059
FP003899 COMMUNITY ACTION, INC. OF Central Texas
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Covered Entity Details
Entity Name
COMMUNITY ACTION, INC. OF Central Texas
Subdivision Name
COMMUNITY HEALTH SERVICES - MLK CLINIC
Type
Family Planning (Title X only)
340B ID
FP003899
Entity Address
215 S. Reimer Ave. Suite 140
SAN MARCOS, TX 78666
Grant Number
FPHPA006521
Participating Start Date
7/1/2013
Last Recertification Date
5/6/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
1/17/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Douglas Mudd, EXECUTIVE DIRECTOR
(512) 392-1161 Ext: 332
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
1/17/2023
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