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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWI19107F ActionAIDS dba Action Wellness
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Covered Entity Details
Entity Name
ActionAIDS dba Action Wellness
Subdivision Name
Type
Ryan White Part A
340B ID
RWI19107F
Entity Address
Action Wellness
3401 I Street
Unit 502
Philadelphia, PA 19134
Grant Number
H89HA00013
Participating Start Date
4/1/2023
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
4/11/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Kevin J. Burns, Executive Director
(215) 981-3338
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/11/2023
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