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AVITA PHARMACY 1061
CH010810 South-West Community Health Center, Inc.
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Covered Entity Details
Entity Name
South-West Community Health Center, Inc.
Subdivision Name
SOUTHWEST COMMUNITY HLTH CTR, INC
Type
HRSA-Funded Health Center
340B ID
CH010810
Entity Address
46 Albion St
Bridgeport, CT 06605-2602
Grant Number
H80CS00613
Participating Start Date
1/1/2004
Last Recertification Date
2/10/2025
Pharmacy Details
Pharmacy Name
AVITA PHARMACY 1061
Pharmacy Address
PHARMBLUE MASSACHUSETTS LLC DBA AVITA PH
163 PLEASANT ST
ATTLEBORO, MA 02703-2457
Pharmacy Comments
Contract Details
Approval Date
7/6/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mollie Melbourne, President/CEO
(203) 332-3501
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/6/2023
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