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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD076012 Buddies of NJ, Inc.
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Covered Entity Details
Entity Name
Buddies of NJ, Inc.
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD076012
Entity Address
149 HUDSON ST
Hackensack, NJ 07601-6861
Grant Number
NU62PS924831-01-00
Participating Start Date
10/1/2021
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
6/2/2023
Contract Begin Date
6/2/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Richard Miles, Executive Director
(201) 344-4412 Ext: 112
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
6/2/2023
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