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PHARMBLUE LLC DBA AVITA PHARMACY 1059
FP191140 Newlands Health
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Covered Entity Details
Entity Name
Newlands Health
Subdivision Name
Type
Family Planning (Title X only)
340B ID
FP191140
Entity Address
9625 Frankford Avenue
Philadelphia, PA 19114
Grant Number
FPHPA006433
Participating Start Date
1/1/2021
Last Recertification Date
5/31/2025
Pharmacy Details
Pharmacy Name
PHARMBLUE LLC DBA AVITA PHARMACY 1059
Pharmacy Address
1226 CHESTNUT ST
PHILADELPHIA, PA 19107
Pharmacy Comments
Contract Details
Approval Date
10/16/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Helena Kwakwa, Medical Director
(215) 941-1236
Contract Pharmacy Representative
Avita
Chris Creamer, COO
(469) 592-2000
Signed By Date
10/16/2023
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