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PHARMBLUE LLC DBA AVITA PHARMACY 1059
RWII55408 University of Minnesota Youth and AIDS Projects
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Covered Entity Details
Entity Name
University of Minnesota Youth and AIDS Projects
Subdivision Name
Type
Ryan White Part B
340B ID
RWII55408
Entity Address
2929 4th ave south
203
Minneapolis, MN 55408
Grant Number
X07HA00028
Participating Start Date
7/1/2024
Last Recertification Date
Entity Termination Date
4/1/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
7/17/2023
Contract Begin Date
10/1/2023
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
4/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Valerie rubin Rubin-RaShaad, Executive Director
(651) 231-4849
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
7/17/2023
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