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PHARMBLUE LLC DBA AVITA PHARMACY 1059
STD07103 North Jersey AIDS Alliance, Inc d.b.a. North Jersey Community Research Initiative (NJCRI)
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Covered Entity Details
Entity Name
North Jersey AIDS Alliance, Inc d.b.a. North Jersey Community Research Initiative (NJCRI)
Subdivision Name
Type
Sexually Transmitted Diseases
340B ID
STD07103
Entity Address
393 Central Ave
Newark, NJ 07103
Grant Number
NU62PS924524
Participating Start Date
10/1/2016
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
10/4/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Brian McGovern, CEO
(973) 849-0084
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/4/2023
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