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PHARMBLUE LLC DBA AVITA PHARMACY 1059
FP130698 OSWEGO COUNTY OPPORTUNITIES INC.
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Covered Entity Details
Entity Name
OSWEGO COUNTY OPPORTUNITIES INC.
Subdivision Name
Fulton Center for Reproductive Health
Type
Family Planning (Title X only)
340B ID
FP130698
Entity Address
522 S 4th Street, Suite 500
Fulton, NY 13069
Grant Number
FPHPA006526
Participating Start Date
1/1/2024
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
10/25/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
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
10/12/2023
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