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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD23231 Nationz Foundation Inc.
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Covered Entity Details
Entity Name
Nationz Foundation Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD23231
Entity Address
1603 Santa Rosa Rd.
101
Richmond, VA 23229
Grant Number
NH25PS005137
Participating Start Date
12/2/2022
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
4/14/2023
Contract Begin Date
7/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Zakia McKensey, Executive Director
(804) 218-4273
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
4/14/2023
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