340B Drug Pricing Program Database
Home
Search
Search Covered Entities
Search Contract Pharmacies
Search Manufacturers
Reports
Help
Login
PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD604221 Proactive Community Services
Print
Covered Entity Details
Entity Name
Proactive Community Services
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD604221
Entity Address
19740 Governors Highway
Suite 118
Flossmoor, IL 60422
Grant Number
6NU62PS924566-05-04
Participating Start Date
4/1/2023
Last Recertification Date
5/15/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
2/10/2023
Contract Begin Date
4/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Eula Burge, CEO/Executive Director
(708) 248-6166
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
2/10/2023
Continue Your Session
For security reasons inactive sessions are automatically closed.
Your session will be closed shortly if you don't continue it.
Continue Your Session