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PHARMBLUE LLC DBA AVITA PHARMACY 1059
FP43338 Morrow County Health Department
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Covered Entity Details
Entity Name
Morrow County Health Department
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP43338
Entity Address
480 Douglas Street
Mt. Gilead, OH 43338
Grant Number
FPHPA006567
Participating Start Date
7/1/2016
Last Recertification Date
5/5/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/10/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Stephanie M Bragg, Health Commissioner
(419) 947-1545 Ext: 308
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/10/2023
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