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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD11207 START Treatment & Recovery Centers, Inc.
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Covered Entity Details
Entity Name
START Treatment & Recovery Centers, Inc.
Subdivision Name
East New York
Type
Sexually Transmitted Diseases
340B ID
STD11207
Entity Address
494 Dumont Avenue
Brooklyn, NY 11207
Grant Number
1NU51PS005167-01-00
Participating Start Date
1/1/2022
Last Recertification Date
5/12/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
5/19/2023
Contract Begin Date
5/24/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jonnel C Doris, Chief Executive Officer
(718) 260-2945
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
5/19/2023
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