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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD13126 OSWEGO COUNTY OPPORTUNITIES - OSWEGO HEALTH CENTER
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Covered Entity Details
Entity Name
OSWEGO COUNTY OPPORTUNITIES - OSWEGO HEALTH CENTER
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD13126
Entity Address
10 GEORGE STREET
OSWEGO, NY 13126
Grant Number
6NH25PS005175
Participating Start Date
7/1/2019
Last Recertification Date
5/16/2023
Entity Termination Date
7/1/2024
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
7/1/2024
Covered Entity Terminated
Contacts
Covered Entity Signing Official
Leanna K Cleveland, Director of Health & Nutrition Services
(315) 529-8329
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/4/2023
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