340B Drug Pricing Program Database

Pharmacy Name

PHARMBLUE LLC DBA AVITA PHARMACY 1059

Pharmacy Address

1226 CHESTNUT ST
PHILADELPHIA, PA 19107

Pharmacy Comments

Approval Date

5/25/2023

Contract Begin Date

6/1/2023

Carve-In Effective Date

Contract Comments

Covered Entity Signing Official

Anthony John Walko III, Chief Executive Officer
(201) 783-3126

Contract Pharmacy Representative

CVS
Alex Hazard, Account Manager
(315) 886-5406

Signed By Date

5/11/2023